Henry S.

Geyer Award Nomination Form

The MU Alumni Association is accepting nominations for the
2007 Henry S. Geyer Awards for Public Service to Higher
Education. This award recognizes the work of two individuals,
one public official and one citizen, who have made a
significant positive impact on higher education and on MU.

Nominees need not be Mizzou alumni.

If you are re-submitting a nomination submitted in the last 2
years, please fill out the form and provide only additional
information you wish to be considered. Past nominations are
kept on file for re-submission.

Your Name: ___________________________________________________________

Organization: __________________________________________________________

Address: ______________________________________________________________

City: _____________________________ State: _____________ Zip: ______________

Phone: _____________________ E-mail: ____________________________________

Nominee Information:

Name of Nominee: ______________________________________________________

Address: ______________________________________________________________

City: _____________________________ State: _____________ Zip: ______________

Phone: _____________________ E-mail: ____________________________________

Please attach the following information, each not to exceed one page in length. If
nominating a current Missouri legislator, there is no need to include the following:
• A summary describing the nominee’s career accomplishments
• A summary describing how the nominee has contributed to the improvement of higher
education and Mizzou

Please return this form by December 29, 2007 to:

Kelley Marchbanks
123 Reynolds Alumni Center
Columbia, MO 65211

Questions? Contact Kelley Marchbanks at 573-882-3941 or MarchbanksK@missouri.edu