Please indicate the appropriate award for your nomination.
Alumni Achievement Award
Alumni Civic Leadership Award
Alumni Service Award
Distinguished Alumni Award
Outstanding Young Alumni Award

Nominator's Information

First Name:

Last Name:

E-mail:

Nominee's Information

First Name:

Last Name:

E-mail:

Address:

City:

State:
Alabama Alaska American Samoa Arizona Arkansas Baker Island California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Jarvis Island Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Maryland Massachusetts Michigan Midway Islands Minnesota Missouri Mississippi Montana Navassa Island Nebraska Nevada New Jersey New Hampshire New York New Mexico Northern Mariana Islands North Dakota North Carolina Ohio Oklahoma Oregon Palmyra Atoll Pennsylvania Petrel Islands Puerto Rico Rhode Island Serranilla Bank South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Wake Island Washington West Virginia Wisconsin Wyoming

Zip Code:

Home Phone:

Business Phone:

Business Name:

Business Address:

Business City:

Business State:
Alabama Alaska American Samoa Arizona Arkansas Baker Island California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Jarvis Island Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Maryland Massachusetts Michigan Midway Islands Minnesota Missouri Mississippi Montana Navassa Island Nebraska Nevada New Jersey New Hampshire New York New Mexico Northern Mariana Islands North Dakota North Carolina Ohio Oklahoma Oregon Palmyra Atoll Pennsylvania Petrel Islands Puerto Rico Rhode Island Serranilla Bank South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Wake Island Washington West Virginia Wisconsin Wyoming

Business Zip Code:

Current Position:

Date of Birth:

Nominee's Hometown/High School:

NMU Degree(s) (include year, type, major):

Other Degree(s) (include year, type, major, name of degree-granting institution):

List significant data to support nomination (include occupational information; attach documentation):

Honors Received, Leadership Roles, Community Service, etc: