Nominate a Wisconsin Academy Fellow

Do you have a friend or colleague who is highly esteemed for their qualities of judgment, perceptiveness, and breadth of knowledge of how literature, art, and science contribute to the cultural life and welfare of our state? Is there a teacher, mentor, civic or business leader in your community that has had a career marked by an unusually high order of discovery and technological accomplishment; creative productivity in literature, poetry, or the fine or practical arts; historical analysis; legal or judicial interpretation; philosophical thinking; or public service? If so, you might know a future Wisconsin Academy Fellow. Please fill out the following nomination form completely and submit it electronically or download a PDF form and mail it and related materials to:

    Fellows Selection Committee
    Wisconsin Academy
    1922 University Avenue
    Madison, WI 53726

Nominations that are not successful for 2012 will be retained by the Wisconsin Academy and automatically reconsidered in each year's selection process for up to three years following the initial nomination. Nominators may submit revised information if they wish to do so, but that will not be required for reconsideration of the candidate.

Three letters of support are required for each nominee. Nominators are also welcome to submit additional materials—things like publications, articles, or image files of art works—in addition to this form and letters of support. Please send all additional materials in digital format to development director Adam Erdmann or via post to Fellows Selection Committee, 1922 University Ave., Madison, WI 53726. Please reference the nominee when sending additional materials.

The nomination deadline for the 2012 Wisconsin Academy Fellows is February 1, 2012.

Thank you for your nomination.

Date: *

Candidate's Name: *

Insert the name of the person you wish to nominate for Fellowship in the Wisconsin Academy, including first, middle, last name

Candidate's Professional Title and Affiliation: *

Insert the title/affiliation the nominee is most likely to use on a regular basis

Mailing Address: *

Insert the complete mailing address of the nominee, including city and zip code

Business Phone: *

Insert the daytime or business telephone number of the nominee

Home Phone:

Insert the home or mobile telephone number of the nominee (if known)

Business e-mail: *

Insert work/daytime e-mail

Home e-mail: *

Insert home/personal e-mail address (if known)

Date and Place of Birth (optional):

Education: *

Insert applicable education and academic credentials, including post-secondary degrees, training, professional certifications, etc.

Curriculum Vitae: *

Insert publications, awards, appointments, projects, events, art exhibitions, etc. that best represent the candidate's major accomplishments

Nominator's Name: *

Insert your name as nominator, please include first, middle, and last name

Nominator's Phone: *

Home or business phone number

Nominator's e-mail: *

Insert your e-mail address

Nominator's Address: *

Your preferred address of contact

Nomination Summary: *

In 500 or less words, please summarize the main reasons for this nomination. Achievement in some area is the main criterion, but interests beyond one's specialty and service to the state and society at large may also be a consideration

Nominate a Wisconsin Academy Fellow

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