Alumni Association

Online Award Nomination Form

The Alumni Association annually bestows awards on deserving alumni and friends of PCO.  Traditionally, the awards are presented at the Annual Dinner dance as part of the Alumni Reunion Weekend.  Complete this form to submit your nomination for any of the awards.

Submit Your Nomination/s

Albert Fitch Memorial Alumnus of the Year Award

This award is presented to an alumnus of the Pennsylvania College of Optometry who has distinguished himself/herself through extraordinary service and contributions to the profession of optometry, bringing honor and prestige to PCO.

Nominee's First Name
Nominee's Last Name 
Nominee's Middle Initial 
Nominee's Title 
Nominee's Graduation Year
Example: 1990 
Nominee's Home Address 
Nominee's Home Address 2 
Nominee's Home City 
Nominee's Home State 
Nominee's Home Zip 
Nominee's Home Phone 
Nominee's Office Address 
Nominee's Office Address 2 
Nominee's Office City 
Nominee's Office State 
Nominee's Office Zip 
Nominee's Office Phone 
Nominee's Fax 
Nominee's Email 
Reason for Nomination 

Distinguished Service Award

This award is presented to a non-alumnus who is closely identified with Salus Univertity and who has provided notable service to the University and their profession..
Nominee's First Name 
Nominee's Last Name 
Nominee's Middle Initial 
Nominee's Title 
Nominee's Business Type 
Nominee's Business Address 
Nominee's Business Address2 
Nominee's Business City 
Nominee's Business State 
Nominee's Business Zip 
Nominee's Business Country 
Nominee's Phone 
Nominee's Fax 
Nominee's Email 
Nominee's Web URL 
Distinguished Nominee Reason 

Public Service Award

This award is presented to a person (or organization), preferably of national standing, which has made a recent significant contribution to Salus University or to their profession.

Nominee's First Name 
Nominee's Last Name 
Nominee's Middle Initial 
Nominee's Title 
Nominee's Organization Type 
Nominee's Business Address 
Nominee's Business Address2 
Nominee's City 
Nominee's State 
Nominee's Zip 
Nominee's Country 
Nominee's Business Phone 
Nominee's Home Phone 
Nominee's Fax 
Nominee's Email 
Nominee's Web URL 
Reason for Nomination 

Special Recognition Award

This award is presented as special recognition of an individual's or organizations's contribution to Salus University, their profession or their community.
Nominee's First Name
Nominee's Last Name
Nominee's Middle Initial
Nominee's Title
Nominee's Organization Type
Nominee's Business Address 
Nominee's Business Address2 
Nominee's City 
Nominee's State
Nominee's Zip
Nominee's Country
Nominee's Business Phone
Nominee's Home Phone 
Nominee's Fax
Nominee's Email
Nominee's Web URL
Reason for Nomination

Nomination/s submitted by
First Name 
Last Name 
Middle Initial 
Title 
Street Address 
Street Address2 
City 
State 
Zip/Postal Code 
Home Phone 
Work Phone 
Fax 
Email Address