University of Nebraska
	UNMC J. G. Elliott Award

	NOMINATION FORM						
The John G. (Jack) Elliott Award of the Chancellor of the University of Nebraska Medical Center will be given annually as provided by Mr. and Mrs. James Massey in memory of Regent Elliott to honor an individual who has made significant contributions to medicine and health programs for the State of Nebraska and for the University of Nebraska Medical Center.  The individual must reside in Nebraska and may be a faculty or staff member of the University. 

Name of Nominee:          
	
Address and Phone:      
	
Brief Biography: 

	

	
Description of Accomplishments Making Nominee Worthy of the J. G. Elliott Award:

	

	
Nominator Name and Title:                                					       Date:   	
All nominations should be forwarded to Bob Bartee, Office of the Chancellor, University of Nebraska Medical Center by August 7.  Final nominations will be submitted by the Chancellor to the Office of the Executive Vice President and Provost, University of Nebraska, by December 10.