Alumni Board of Directors Nomination Form

Nominee's Personal Information
Name First Last
Address
Street address Address line 2 City State/Province/Region Postal/Zip code Country
Preferred Phone - Area Code - Prefix Line Number
Which Phone is this?
Email
Employment Info or Employer
Title
Nominee's Academic Information
Class Year(s)
Degree/Focus
Brief statement in support of nominee
If known, professional affiliations
If known, volunteer activities, awards, honors relevant to the field of 黑马磁力 and/or Indiana University
Nominator's Information
Name First Last
Phone - Area Code - Prefix Line Number
Email
Additional supporting documentation (letter of recommendation, resume, etc.)

Attach Files
Nominator's signature e-mail will suffice as electronic signature

e-mail will suffice as electronic signature

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