Alumni Nomination form

Select Award:

Name of Nominee:
Graduation Year:
Maiden Name : (if applicable)
Address:
City:
State:
Zip:
Email:
Work Telephone:
Home Telephone:

Employment History - Please list the nominee's current employer first.
Employer:
Title:
Employment Start Date:
Specific accomplishments, honors, awards while in this position:

Employer:
Title:
Employment Start Date:
Specific accomplishments, honors, awards while in this position:

Education - Please list all college/universities attended, after Simpson and any graduate or post-graduate institutions.
Institution:
Years Attended:
Major(s):
Degree Earned, Date:

Institution:
Years Attended:
Major(s):
Degree Earned, Date:

Simpson Activities and Honors as a Student:

Community and/or Professional Activities, Service, Honors, etc., After Attending Simpson:

Family (Please List, if any, Spouse and Children. Also Indicate any Family Members who have Attended or are Attending Simpson.):

Service to Simpson College (As an Alumnus/ae, Please List any Volunteer Work Provided, Giving History, Board Membership, etc.):

Reason for Nomination (Please State why you Believe this Person is a Qualified Candidate for an Alumni Award or the Alumni Board of Directors. Please note if nomination is for the Board.):


This form was filled out by (please include class year if an alumnus/a):
Name:
Phone Number:
Email: *
Your Relationship to Nominee:

Simpson College