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Alumni Award Program Nomination Form

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Nominee (Please provide the following information about yourself or the person you are nominating)
First Name:*
Middle Name/Initial:
Last Name:*
Address 1:*
Address 2:
City:*   State:*   Zip:*
Phone Type:*
Phone Number (555-555-5555):*
Email Address:*
Date of Birth:*
Dates attended LMC or year graduated:
If selected, will nominee be present to accept the award at Lake Michigan College's commencement on May 3, 2015 at 2:00 pm?    
College(s) & Degree Earned:*    Attended/Graduated:*
College(s) & Degree Earned:    Attended/Graduated:
College(s) & Degree Earned:    Attended/Graduated:
Current Employer:*
Description of Job:
Other Information
Other Professional Positions:
Professional Memberships:
Personal Achievements:
Civic Memberships and Community Activities:
Other Honors and/or Awards Received:
Personal Interests and/or Accomplishments:
Additional Information that may be relevant to this award:
Nominator (If you are nominating yourself, skip this section. If you are nominating someone else,please provide your information below.)
First Name:
Middle Name/Initial:
Last Name:
Address 1:
Address 2:
City:   State:   Zip:
Phone Type:
Phone Number (555-555-5555):
Email Address:
Relationship to nominee:
I have informed the nominee that I am submitting her/his name for an alumni award.    

* indicates required information