*
Required
DGO Nomination Form
Who is your Nominee?
First Name
*
required
Last Name
*
required
PWHS Graduation Year
*
required
Occupation
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required
In one or two short sentences, why should this person be recognized as a Distinguished PWHS Graduate?
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required
Education
Has the Nominee earned a college degree?*
Yes
No
Earned Degree
*
required
School
*
required
City/State
*
required
Year(s) of Degree or Attendance
*
required
Do you have another Earned Degree to list?
Yes
Earned Degree
*
required
School
*
required
City/State
*
required
Year(s) of Degree or Attendance
*
required
Do you have another Earned Degree to list?
Yes
Earned Degree
*
required
School
*
required
City/State
*
required
Year(s) of Degree or Attendance
*
required
Do you have another Earned Degree to list?
Yes
Earned Degree
*
required
School
*
required
City/State
*
required
Year(s) of Degree or Attendance
*
required
Do you have another Earned Degree to list?
Yes
Earned Degree
*
required
School
*
required
City/State
*
required
Year(s) of Degree or Attendance
*
required
Has the Nominee received an Honorary Degree?*
Yes
No
Honorary Degree
*
required
School
*
required
City/State
*
required
Year Awarded
*
required
Do you have another Honorary Degree to list?
Yes
Honorary Degree
*
required
School
*
required
City/State
*
required
Year Awarded
*
required
Do you have another Honorary Degree to list?
Yes
Honorary Degree
*
required
School
*
required
City/State
*
required
Year Awarded
*
required
Does the Nominee have any Professional Certifications?*
Yes
No
Certification
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required
Certifying Body
*
required
Do you have another certification to list?
Yes
Certification
*
required
Certifying Body
*
required
Do you have another certification to list?
Yes
Certification
*
required
Certifying Body
*
required
Do you have another certification to list?
Yes
Certification
*
required
Certifying Body
*
required
Is there something you'd like to add regarding the Nominee's education?
Yes
Please explain:
Career History
Position
*
required
Organization
*
required
City/State
*
required
Year From-To
*
required
Do you have another position to list?
Yes
Position
*
required
Organization
*
required
City/State
*
required
Year From-To
*
required
Do you have another position to list?
Yes
Position
*
required
Organization
*
required
City/State
*
required
Year From-To
*
required
Do you have another position to list?
Yes
Position
*
required
Organization
*
required
City/State
*
required
Year From-To
*
required
Do you have another position to list?
Yes
Position
*
required
Organization
*
required
City/State
*
required
Year From-To
*
required
Are you basing your nomination on your Nominee's professional achievements?*
Yes
No
Describe your Nominee's greatest professional accomplishment(s).
*
required
Is there something you'd like to add regarding the Nominee's career history?
Yes
Please explain:
Military Service
Has your Nominee ever served in the military?*
Yes
No
Branch of Service
*
required
Year From-To
*
required
Location
*
required
Highest Rank
*
required
Do you have more military service to list?
Yes
Branch of Service
*
required
Year From-To
*
required
Location
*
required
Highest Rank
*
required
Do you have more military service to list?
Yes
Branch of Service
*
required
Year From-To
*
required
Location
*
required
Highest Rank
*
required
Do you have more military service to list?
Yes
Branch of Service
*
required
Year From-To
*
required
Location
*
required
Highest Rank
*
required
Do you have more military service to list?
Yes
Branch of Service
*
required
Year From-To
*
required
Location
*
required
Highest Rank
*
required
Are you basing your nomination on your Nominee's military service?*
Yes
No
Describe your Nominee's greatest accomplishment(s) in the area of military service.
*
required
Is there something you'd like to add regarding the Nominee's military service?
Yes
Please explain:
Professional Memberships
Has your Nominee been a part of any professional organizations/committees/etc.?*
Yes
No
Organization
*
required
City/State
*
required
Year From-To
*
required
Position
*
required
Do you have another organization or committee to list?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Position
*
required
Do you have another organization or committee to list?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Position
*
required
Do you have another organization or committee to list?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Position
*
required
Do you have another organization or committee to list?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Position
*
required
Do you have another organization or committee to list?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Position
*
required
Media
Has your Nominee been featured in the media?*
Yes
No
What medium/media?*
Check all that apply.​​
Website
Television
Radio
Magazine
Newspaper
Book
Website
Website Name
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required
Title of Story
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required
Year Published
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required
Link (if available)
Do you have another website feature to list?
Yes
Website Name
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required
Title of Story
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required
Year Published
*
required
Link (if available)
Do you have another website feature to list?
Yes
Website Name
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required
Title of Story
*
required
Year Published
*
required
Link (if available)
Do you have another website feature to list?
Yes
Website Name
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required
Title of Story
*
required
Year Published
*
required
Link (if available)
Do you have another website feature to list?
Yes
Website Name
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required
Title of Story
*
required
Year Published
*
required
Link (if available)
Television
TV Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Do you have another television feature to add?
Yes
TV Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Do you have another television feature to add?
Yes
TV Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Do you have another television feature to add?
Yes
TV Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Do you have another television feature to add?
Yes
TV Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Do you have another television feature to add?
Yes
TV Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Radio
Radio Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Do you have another radio feature to add?
Yes
Radio Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Do you have another radio feature to add?
Yes
Radio Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Do you have another radio feature to add?
Yes
Radio Show
*
required
Segment/Story Title (if any)
Distribution*
Local
National
Year broadcast
*
required
Link (if available)
Magazine
Magazine Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another magazine feature to add?
Yes
Magazine Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another magazine feature to add?
Yes
Magazine Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another magazine feature to add?
Yes
Magazine Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another magazine feature to add?
Yes
Magazine Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another magazine feature to add?
Yes
Magazine Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another magazine feature to add?
Yes
Magazine Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Newpaper
Newspaper Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another newspaper feature to add?
Yes
Newspaper Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another newspaper feature to add?
Yes
Newspaper Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another newspaper feature to add?
Yes
Newspaper Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another newspaper feature to add?
Yes
Newspaper Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Do you have another newspaper feature to add?
Yes
Newspaper Title
*
required
Article Title
*
required
Distribution*
Local
National
Year published
*
required
Link (if available)
Book
Book Title
*
required
Author
*
required
Publisher
*
required
Year published
*
required
Do you have another book to add?
Yes
Book Title
*
required
Author
*
required
Publisher
*
required
Year published
*
required
Do you have another book to add?
Yes
Book Title
*
required
Author
*
required
Publisher
*
required
Year published
*
required
Do you have another book to add?
Yes
Book Title
*
required
Author
*
required
Publisher
*
required
Year published
*
required
Do you have another book to add?
Yes
Book Title
*
required
Author
*
required
Publisher
*
required
Year published
*
required
Do you have another book to add?
Yes
Book Title
*
required
Author
*
required
Publisher
*
required
Year published
*
required
Community Involvement
Is your Nominee involved in the community?*
Yes
No
Organization
*
required
City/State
*
required
Year From-To
*
required
Positions Held
*
required
Do you have more community involvement to add?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Positions Held
*
required
Do you have more community involvement to add?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Positions Held
*
required
Do you have more community involvement to add?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Positions Held
*
required
Do you have more community involvement to add?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Positions Held
*
required
Do you have more community involvement to add?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Positions Held
*
required
Do you have more community involvement to add?
Yes
Organization
*
required
City/State
*
required
Year From-To
*
required
Positions Held
*
required
Are you basing your nomination on your Nominee's community involvement?*
Yes
No
Describe your Nominee's greatest accomplishment(s) in the area of community involvement.
*
required
Is there something you'd like to add regarding the Nominee's community involvement?
Yes
Please explain:
Awards/Honors/Grants
Has your Nominee won any Awards, Honors or Grants?*
Yes
No
Award/Honor/Grant
*
required
Granting Body
*
required
Location (if applicable)
Year
*
required
Do you have another Award, Honor or Grant to list?
Yes
Award/Honor/Grant
*
required
Granting Body
*
required
Location (if applicable)
Year
*
required
Do you have another Award, Honor or Grant to list?
Yes
Award/Honor/Grant
*
required
Granting Body
*
required
Location (if applicable)
Year
*
required
Do you have another Award, Honor or Grant to list?
Yes
Award/Honor/Grant
*
required
Granting Body
*
required
Location (if applicable)
Year
*
required
Do you have another Award, Honor or Grant to list?
Yes
Award/Honor/Grant
*
required
Granting Body
*
required
Location (if applicable)
Year
*
required
Do you have another Award, Honor or Grant to list?
Yes
Award/Honor/Grant
*
required
Granting Body
*
required
Location (if applicable)
Year
*
required
Do you have another Award, Honor or Grant to list?
Yes
Award/Honor/Grant
*
required
Granting Body
*
required
Location (if applicable)
Year
*
required
Avocations
Hobbies/Recreational Activities
*
required
Additional Information
Is there anything else you'd like to add?*
Yes
No
Please explain.
*
required
Nominee Contact Information
Email
*
required
Phone
*
required
Address
*
required
City
*
required
State
*
required
Zip
*
required
Is your Nominee married?*
Yes
No
Spouse's Name
*
required
Does your Nominee have any children?*
Yes
No
Children's Names
*
required
Submitted By
Name
*
required
Email
*
required
Phone
*
required