Pages - NominationForm

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?	Yes No

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