Scholars Hall of Fame Nomination - Southwestern College

Nomination Ballot

Scholars Hall of Fame
Person being nominated: (Southwestern College alumni only)

First NameLast Name
Graduation Year:
(YYYY)
Significant Achievements and Accomplishments of Nominee:
Your Information
Your Name:

First NameLast Name
E-mail:
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Nomination Date:

MonthDayYear
Should be Empty: