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Distinguished Alumni Nomination Form

Print Version (Instructions included; print, complete, and submit.)

Online Version Instructions

Part B Instructions:

Address all four categories and list specific examples in each.
Space is provided for lengthy descriptions in each category.
Descriptions may be keyed directly into the form.
Helpful Tip: Type your responses to all four categories in Part B in word processing software first, then save and edit as needed. You can then copy the information into the online form.
Note: The selection committee bases its decision on the information submitted in Part B.

The deadline for submitting the nomination is January 31, 2008.

Part A

I nominate the following individual for the CVTC Distinguished Alumni Award:
Name
Home Address
City	State Zip
Daytime Phone	Evening Phone
Program	Year Graduated
Current Employer
Position
Nominee's Business Address
City	State Zip
Phone Number	Fax Number

Part B

1. Leadership. Provide statements indicating how the nominee has exhibited outstanding leadership and character in his/her career, community and personal life.

2. Occupation. List nominee's occupation and describe noteworthy accomplishments of nominee in his/her field.

3. Community. Provide statements of nominee's service and contribution to the community through civic, religious, charitable, business, professional, or other means.

4. Chippewa Valley Technical College. Provide statements of support given to CVTC of time, talent or treasure. Examples: Hiring CVTC graduates, advisory committee membership, monetary or in-kind contributions, etc.

Part C

Nomination Submitted By:
Name
Home Address
City	State Zip
Daytime Phone	Evening Phone
How did you hear about CVTC's Distinguished Alumni Award?

Thank you for your nomination.