University of Nebraska
 Regents Medal Awards

NOMINATION FORM

The Regents Medals are awarded to individuals whose service to the University has provided exceptional benefits in furtherance of the goals and mission of the institution.  The following are guidelines in selecting the Award recipients:

•	Achievements of the nominee should be University or State oriented.
•	Nominee should be a resident of the State of Nebraska.  If the nominee was a resident and has now left the State, his/her contribution should be Nebraska oriented.

Nominations for this award are made by the Board of Regents and the President. The Medals shall not be awarded to current employees, any office holder of or candidate for any elective state constitutional office, including state senator, or to any office holder or candidate for the U.S. House Representatives or U.S. Senate from the State of Nebraska.  However, past employees or retirees of the university are eligible for the Regents Medals.

Name of Nominee:
	
Complete Address and Phone Number:

Brief Biography:

	
Description of Accomplishments Qualifying Nominee for Award:

	
Name and Title of Nominator:                                                                             Date:	

Please send to the Office of the Executive Vice President and Provost, University of Nebraska, 133 Varner Hall, 3835 Holdrege, Lincoln, NE 68583-0743, fax to (402) 472-4240, or email to evpp@nebraska.edu by December 10, 2018.