Blackburn College Alumni Association Award Nomination Form

Candidate for: (please check the award for your nominee)

	Distinguished Alumni Award (alumni who have demonstrated significant contributions to society or a profession)
	Alumni Achievement Award (alumni who have demonstrated significant achievement in personal or public career)
	Harold & Elizabeth Ziegler Service Award (individuals who have rendered loyal volunteer service to Blackburn during the past year)
	Gideon Blackburn Recognition Award (individuals who have rendered valuable service to the College in terms of time, money, influence, service, etc.)

Name of Nominee:	Address of Nominee:
Phone Number of Nominee:	Name of Spouse:
Blackburn Class Year (if applicable):	Type of Degree:
Blackburn Academic Major:

Further Academic Career (include institution(s) & area(s) of study):

Employment Biography (include employer(s), position(s), & achievements):

Statement of why you feel the nominee is an excellent choice for this award:

Name of the person making the nomination: