Alumni Nomination Form

Select Award
Name of Nominee:*
Graduation Year:
Address
Street AddressCityState / Province / RegionZIP / Postal Code
Email
Work Phone
Home Phone
Employment History - Please list nominee's current employer first.
Employer:
Title:
Specific accomplishments, honors or awards while in this position:
Employer:
Title:
Specific accomplishments, honors or 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 volunteet 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.
This form was filled out by (please include class year if alumnus/ae):
Name
FirstLast
Phone
Email
Relation to Nominee:

Employment History - Please list nominee's current employer first.