Honorary Degree Nomination Form

* indicates required field

A nominator letter of support is to accompany this form. Three additional reference letters with original signatures are required for the nomination process. The application will not be considered complete until the reference letters accompanying the nomination are received.

Please send all reference letters to:
The Honorary Degree Committee at Utica University
1600 Burrstone Road
Utica, NY 13502-4892

Nominee Information

Name of Nominee

Proposed Award

Present Position

Relationship to Utica University

Support Statement (if not currently related to Utica University)

Street Address

City

State

Alabama Alaska Alberta American Samoa Arizona Arkansas Australian Capitol Territory British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Foreign State Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Military - Americas Military - Europe Military - Pacific Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New South Wales New York Newfoundland Newfoundland and Labrador Norfolk Island North Carolina North Dakota Northern Mariana Islands Northern Territory Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Provence of Quebec Puerto Rico Quebec Queensland Rhode Island Saskatchewan South Australia South Carolina South Dakota Tasmania Tennessee Texas Utah Vermont Victoria Virgin Islands Virginia Washington West Virginia Western Australia Wisconsin Wyoming Yukon Territory

Zip Code

Email Address

Land Phone

Mobile Phone

Fax

Nominee Education

Nominee Awards

Nominator Information

Nominated By

Utica Faculty

Address

City

State

Alabama Alaska Alberta American Samoa Arizona Arkansas Australian Capitol Territory British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Foreign State Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Military - Americas Military - Europe Military - Pacific Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New South Wales New York Newfoundland Newfoundland and Labrador Norfolk Island North Carolina North Dakota Northern Mariana Islands Northern Territory Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Provence of Quebec Puerto Rico Quebec Queensland Rhode Island Saskatchewan South Australia South Carolina South Dakota Tasmania Tennessee Texas Utah Vermont Victoria Virgin Islands Virginia Washington West Virginia Western Australia Wisconsin Wyoming Yukon Territory

Zip Code

Email Address

Phone

Fax

Support Statement

Nominator's Brief Statement of Support