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

Month

Year

Mailing Address: *

Telephone:

Fax:

E-mail:

References: *

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.