Leaders in Service Hall of Fame Nomination

Nomination Ballot

Leaders in Service Hall of Fame
Person being nominated: (Southwestern College Alumni or Friend of SC only )

First NameLast Name
This nominee is a:
Years attended SC:
Years involved with SC:
Significant Achievements and Accomplishments of Nominee in the field of Social Sciences (political science, religion, philosophy, leadership, history, anthropology and psychology):
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