Distinguished Alumni Nomination Form

Nominee:

Full Name: *

Telephone:

Mailing Address: *

E-mail:

Nominee's Current Position/Occupation:

Nominee's educational attainment at Lakehead University:

Other Degrees:

The nominee: *

Does know that they have been nominated for this award

Does not know that they have been nominated for this award

Nominator:

Full Name: *

Date: *

Day

Month

Year

Mailing Address *

Telephone:

E-mail:

References: *

Attachments *

Please review the Nomination Guidelines for the Distinguished Alumni Award and attach the appropriate supporting documentation and references. Additional materials are not required.
Files must be less than 2 MB.
Allowed file types: pdf doc docx odt.