Alumni Membership Card Request

Your Information (nominator)

Prefix

First Name

Middle Name

Last Name

Suffix

Professional Suffix

UMBC Affiliation

Secondary UMBC Affiliation

Country Code

Address Line 1

Address Line 2

City

State

State Abbreviation

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Zip/Postal Code

Home Phone Number

Primary Email

Confirm Email

Is the nominee aware of your nomination?

YesNo

I would like to nominate:

UMBC GraduateFaculty MemberStaff MemberPlease note that while anyone may make nominations in the alumni categories, only alumni may make nominations for the faculty and staff categories.

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Opportunity Record Type ID

Educational Institution Account Record Type ID

Lead Source Campaign ID

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utm_medium

utm_campaign

utm_term

utm_content

utm_date

url_source

full url

base url

Information About the Nominee

If you do not have this information, please write in NA.

Name of Nominee

Nominee's UMBC Grad Year

If applicable.

Nominee's UMBC Major

If applicable.

Nominee's Home Address (Please include street, city, state, and zip)

Nominee's Daytime Phone Number

Nominee's Email Address

Nominee's Employer

Nominee's Job Title

Nominee's LinkedIn or Website

Which award are you nominating this person for?

Outstanding Alumni of the YearDistinguished Service AwardRising Star Award (only those who received an undergraduate degree between 2015-2025 are eligible)Outstanding Faculty AwardOutstanding Staff Award

Why are you nominating this person for this award?

(Please Note: We suggest you type your response in a Word document and copy and paste it into the online form.)

Please address the following:

What are the nominee's significant contributions to their profession? (For nominees for the Rising Star Award, it is appropriate to include information that speaks to their achievements as a student, and how their potential is already shown in the early part of their career.)

Please note there is a max of 300 words.

How has the nominee been involved in the greater community through volunteer leadership or community service?

Please note there is a max of 300 words.

How has the nominee continued to support or remain involved with UMBC as a graduate?

Please note there is a max of 300 words.

Please also provide any additional information you would like the committee to know about this nominee.

Please note there is a max of 300 words.

Please attach supplemental documents

Please attach up to two documents.

Alumni Membership Card Request

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