Clark College Foundation

Clark College Alumni Association Outstanding Alumni Award Nomination

Outstanding Alumni Award Nomination NOMINEE INFORMATION

* Required information. To ensure your nominee receives maximum consideration, please fill-in form as completely as possible. Nominations must be received by December 31.

Full Name*

Address1

Address2

City

State

Zip

Phone (including area code)*

Email

Current Employer

Title/Position

Address1

Address2

City

State

Zip

Years attended Clark College (e.g., 1961-1963)

Is nominee a graduate of Clark College?

Nominee's Accomplishments and Contributions NOMINEE'S ACCOMPLISHMENTS AND CONTRIBUTIONS
Outstanding Professional Qualities:

Contributions to the community through community service or volunteer work:

Contribution to the spirit and values of Clark College through continued involvement with the college:

Other accomplishments and contributions:

Additional information ADDITIONAL INFORMATION
Attach a document (If desired, attach a document containing additional information about the nominee. Microsoft Word and Adobe Acrobat (pdf) files are accepted.)

Nominator's Information NOMINATOR'S INFORMATION
Full Name*

Phone (including area code)*

Email*

Relationship to Nominee*

Please provide the names of two additional individuals who are familiar with the candidate and would endorse this nomination

Full Name

Phone (including area code)

Email

Full Name

Phone (including area code)

Email