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Distinguished Alumni Service Award

• Learn about DASA regulations
• Download and print the DASA regulations and nomination form

For a mailed nomination form, please call Bilen Mulugeta at the IUAA:

Phone: (812) 855-9867
(800) 824-3044

All information is confidential in the files of the Awards Committee.

Nominee's Information

1. Required items are in dark red
2. Title:
   • Mr.
   • Ms.
   • Mrs.
   • Miss
   • Dr.
3. First Name:
4. Last Name:
5. Date of birth:
6. Place of birth:
7. Street Address:
8. City:
9. State:
10. ZIP:
11. Business Street:
12. Business City:
13. Business State:
14. Business ZIP:

Nominee's Education:

1. Degree(s) and year(s) graduated from IU:
2. If not a graduate, when attended IU:
3. Other universities attended, with dates:
4. Degree(s) from other universities:

Nominee's Employment History

1. Present occupation:
2. Former Positions: Position Dates Held
3. Position 1:
4. Position 2:
5. Position 3:
6. Position 4:
7. Position 5:
8. Membership in professional, business, civic, social, and similar organizations:
10. Describe eminent services and achievements in the nominee's chosen field of endeavor, such as law, medicine, business, science, music, teaching, writing, administration, etc.
12. Describe significant contributions by nominee that benefit community, state, or nation through public service, civic activities, social service, university, armed forces, or any other activity.
14. Additional information regarding nominee's qualifications for the Distinguished Alumni Service Award:

Nominator's Information

1. First Name:
2. Last Name:
3. Street Address:
4. City:
5. State:
6. ZIP:
7. E-mail Address:

Nominations must be submitted no later than December 31.

Additional materials (letters of recommendation, etc.) should be mailed to:

Coordinator, DASA Alumni Awards
c/o President and CEO
Indiana University Alumni Association
Virgil T. DeVault Alumni Center
1000 E. 17th St.
Bloomington, IN 47408-1521