Alumnus of the Year Nomination Form

Nominator Information

Name:
School and Class Year:
Department/School:
Daytime Phone (with area code):
Address:
City, State, Zip:
E-mail:
Does this alumnus know that you are nominating him/her? Yes No
May we disclose your name to the nominee? Yes No

Nominee Information

Name:

School and Class Year:

Address:

City, State, Zip:

Home Phone (with area code):

Email:

Spouse Name:

Did Spouse Attend Regent
University:

Yes No

Children and Ages:

Job Title/Position:

Company/Employer Name:

Business Address:

Business City, State, Zip:

Business Phone (with area code):

Professional Affiliations and Honors Received :

Books or Articles Written:

Explain the nature of their career or field of endeavor:

How have they distinguished themselves within the field:

How have they demonstrated service to the Christian community:

How has this alumnus' accomplishments inspired others:

How did their education at Regent contribute to their success:

How has this alumnus demonstrated continuing interest in and support of Regent:

Additional comments that you would like the committee to know about this alumnus:

In addition to this form you may submit other information for the committee's consideration which will demonstrate qualifications. This may include a vita, newspaper or magazine clippings, etc. Please be as concise as possible in order to facilitate the sharing of this information with the committee.

If mailing the nomination and supporting materials, please send to:

Office of Alumni Relations
Attn: Alumnus of the Year Awards Committee
1000 Regent University Drive, ADM 116
Virginia Beach, VA 23464



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