OUTSTANDING ALUMNUS AWARD NOMINATION FORM

Name of Nominee: ______________________________________________________________

Last
First
Middle
(Maiden Name, if
applicable)
Year of Graduation in Maryknoll/Maryhill ________
Gr. _____

HS______

College____________

(What year did the person you are nominating graduate from Maryknoll/Maryhill?)

Degree/Major received from other

college/university____________________________________
Gender:

____ Female ___ Male

Home Address of Nominee:

_______________________________________________________________________________
(Number and Street, City, and Zip Code)
Home/Mobile Phone of Nominee: ___________________________________________________
Business Address: ________________________________________________________________
Business Title: ___________________________________________________________________
Nature of Job/Work: ______________________________________________________________
Business Phone:______________________________________________________
E-mail address:_______________________________________________________
If married, is spouse an MC alumnus/a?
_____Yes _____ No
If yes, year of graduation:__________
Person submitting Information:
Name:______________________________________
Address:____________________________________________________________
Phone: __________________________________________________________
E-mail address: _______________________________________________
Relationship to the nominee:___________________________________
How do you know the person you are
nominating?:______________________________________