Distinguished Alumni Awardee Information

First and Last Name:*

Name as you would like it to appear on award:*

Will you be attending the Night of Distinction celebration on MSUM's campus on October 12, 2023?*

Yes

No

Maybe

Which nights will you need a hotel room in Fargo/Moorhead? (Your room will be covered (excluding incidentals) by the MSUM Foundation.)*

Thursday, October 12

Friday, October 13

Mailing Address (Street, City, State, Zip):*

Phone Number:*

Email Address:*

Current/Preferred Job Title:*

You can upload multiple files at once using these tips:

Make sure your files are all in the same location on your device.
Mobile device: Hold your finger down on one of the files until it is selected with a checkmark and then you can select the other files you want to upload.
Laptop/desktop: Hold down the shift key and click on the files you want to upload.

File types allowed jpg, jpeg, png, tif, gif, pdf

You can upload multiple files at once using these tips:

Make sure your files are all in the same location on your device.
Mobile device: Hold your finger down on one of the files until it is selected with a checkmark and then you can select the other files you want to upload.
Laptop/desktop: Hold down the shift key and click on the files you want to upload.

File types allowed jpg, jpeg, png, tif, gif, pdf

Please upload a high-resolution headshot.

Please upload 5-10 photos capturing your accomplishments, college photos, or professional photos you've had taken.

Please upload 5-10 photos capturing your family, hobbies and interests.

Congratulations! We are looking forward to celebrating you at the Night of Distinction.