Outstanding Alumnus Award Nomination Form |

Please complete this form providing as much of the information as possible. Recipients are selected on an annual basis; nomination forms are due on or before March 1st .

Date of Nomination:*

Alumni Award Category*

Nominee's Information

Nominee*

First Last

Nominee's Home Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Nominee's Phone Number

Program/Year Graduated

Current Employer

Position

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Telephone

Nominator's Name

First Last

Nominator's Phone Number

Nominator's Email Address

In what capacity do you know the nominee? (Friend, Co-worker, etc.)

How did you hear about the Outstanding Alumnus Awards?

How has this person shown growth, achievement and leadership in his or her personal and professional life since graduation? (e.g., career achievements, obstacles overcome, etc.)

How has this person demonstrated commitment and service to others through contributions of time, talents or treasure? (e.g., community service, service clubs, church, volunteerism, etc.)

(Alumnus Awards only) How has this person shown his or her support of North Central Kansas Technical College (NCK Tech) since graduating? (e.g., financial, board representative, advocacy, volunteerism, support/employment of graduates, etc.)

(Faculty/Staff Award only) What is your favorite memory of this faculty/staff member?

Email

This field is for validation purposes and should be left unchanged.

Outstanding Alumnus Award Nomination Form

Please complete this form providing as much of the information as possible. Recipients are selected on an annual basis; nomination forms are due on or before March 1st .

Nominee's Information

Beloit Campus

Hays Campus