Distinguished Alumni Award Nomination

Please complete this questionnaire in it's entirety! Each year during alumni weekend, the College recognizes alumni for outstanding career achievement and/or distinguished service to Lake Erie College. The recipients are selected by the National Alumni Board, which reviews recommendations submitted by alumni, faculty, staff and friends of the College.

Contact Information

Name (First, Last):

E-Mail:

Phone #:

Address:

City:

State:

Zip:

Country:

Candidates Information

Candidates Name (First, Last):

Candidates E-Mail:

Candidates Phone #:

Candidates Address:

Candidates City:

Candidates State:

Candidates Zip:

Candidates Country:

Candidates Year of Graduation:

Candidates Major/Minor:

Candidates Professional Information

Professional Experience:

Graduate Work:

Employer:

Candidates Organizational Membership

Professional:

Civic:

Charitable:

Candidates Noteworthy Achievement & Contributions

Education:

Science & Arts:

Community:

Professional:

Service to LEC:

Awards & Honors Received:

Other Information or Comments:

Please type the verification image:

Fall 2012 Alumni Magazine

Distinguished Alumni Award Nomination