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Marian University

Distinguished Alumni Award Nomination Form

All nominations and supporting documents must be received by Tuesday, March 26, 2013 to be considered.

Alumni many nominate themselves.

* denotes required fields

 

Nominee

*First Name  

*Last Name  

Middle Name

Maiden Name

*Class Year  

Spouse's Full Name
Indicate if spouse is a Marian University graduate.

Children's Names
Indicate if they are Marian University graduates or students.

Are you nominating yourself?


 

Nominee's Contact Information

Address

City

State

Zip

Phone
(include codes/prefixes, i.e. 317.955.6000)

E-Mail Address

 

Nominee's Educational and Employment Information

Marian University (Marian College) Degree

Major

Minor

Additional Education
List institutions attended and degrees attained.

Employment
List business or organization and job title.

 

Accomplishments

Please list the nominee's professional history and accomplishments:

Please list the nominee's community, parish, or other involvements:
Indicate current roles, as well as leadership and volunteer roles.

Please list any honors, awards, or recognition the nominee has received for professional, community, and volunteer activities:

List any additional service to Marian University:
E.g. employment by the University; work with the alumni association; service on the Board of Trustees; or other volunteer participation at Marian University (Marian College).  

Include any additional pertinent  information for the selection committee's deliberations