Alumnus Nomination Form

In 1995, the Faculty Senate Executive Council initiated a program to recognize an outstanding alumnus at commencement each year. We want to invite college employees and members of the community to participate in the search for the Outstanding Alumnus to be recognized.

Please fill out this brief form and submit it to the committee chairperson, Susan Todd. The nominees will receive a questionnaire so they can provide information about how well they meet the criteria. A committee will review the answers and make a final selection.

The Outstanding Alumnus is a person who:

• graduated from Jefferson College with a certificate or associate degree
• has achieved distinction in his/her chosen field of employment
• has been involved in community service
• is not presently a trustee or an employee of Jefferson College

Outstanding Alumnus of the Year Nomination Form

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I (insert name below) *

wish to nominate (insert alumni below) *

who graduated from Jefferson College in (insert year below) *

Please provide a brief paragraph explaining why the nominee deserves the award. *

Nominee Street Address *

Nominee City *

Nominee State *

Nominee Zip Code *

His/her phone number is *

His/her email address is *

or Nominee year

For more information, I (the nominator) can be reached at *

Phone Number

or *

Email Address

Submit