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Hartnell College Alumni Association

2012 Distinguished Alumnus/Alumna Nomination

DUE: March 23rd, 2012
YOUR Name: *  
YOUR Phone: *  
YOUR Email: *  
Nominee Name: *  
Nominee's Address:  
Nominee Home Phone: *  
Nominee Work Phone:  
Nominee's Current Employment:  
Nominee's year of attendance at Hartnell:  From: to
Nominee's Major:  
Nominee's Units Completed:  
Hartnell Degree(s) Certificate(s) awarded to Nominee, Year and area of study:   
Nominee Transferred to:  

Please fill in the areas below to the best of your ability:

1. About the Nominee:
Please provide a brief biographical paragraph (marital status, spouse’s name, children, hobbies and interests):

2. Basis for nomination:
(Achieved distinction in his/her chosen field of endeavor and/or have demonstrated on-going and extensive contributions to the College.

(* denotes required fields)