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:

Nomination Ballot