Nominee's Information

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*Name of Nominee:

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Address:

City:

State:

Zip:

Phone Number:

Email:

Year Graduated (if RIT alum):

Degrees(s):

*Please describe the outstanding creative/technical engineering/artistic accomplishments to merit this award:

Please detail the nominee's accomplishments.

*Impact of this work:

Please detail the impact of the accomplishments listed above.

*References or documentation that may further support this information:

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Your Information

*Your Name:

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*Address:

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*City:

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*State:

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*Zip:

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*Phone Number:

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*Email:

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Year Graduated (if RIT alum):

Degree(s):

Connection to Nominee:

One or more mandatory pieces of information has been left blank. Please review the form and provide all mandatory information. A field is filled with a value not in the correct format (i.e. email, zip code).