Exceptional Alumni Nomination Form Nominee: Full Name: * Mailing Address: * Telephone: Fax: E-mail: Current Position or Occupation: Educational attainment at Lakehead University: * Other Degrees The Nominee: * Does know that they have been nominated Does not know that they have been nominated Nominator: Full Name: * Date: * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20212022202320242025 Mailing Address: * Telephone: Fax: E-mail: References: * Name, Title Name, Title Attachments * Please review the Nomination Guidelines for the Exceptional 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.