Distinguished Alumnus Award Nomination - Stephen F. Austin State University Alumni Association

Distinguished Alumnus Award Nomination

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DEADLINE MARCH 15

NOMINATED BY:

Your name
Home address *
City, State, Zip
Daytime phone *
Evening phone *
Email address *
.

NOMINEE INFORMATION

First Name *		Last Name *
School / Department
Highest Degree Attained *
Home Address *
City *		State *
Zip/Postal Code *
Phone Area Code *		Phone *
Office Phone Area Code *		Office Phone *
SFA Alumni Assoc. Member No. *
Earned DegreesPlease list each earned or honorary degree, school, city/state and year degree attained.
SFA AffiliationsPlease list contributions to SFA of time, talent, influence or funds by nominee.
Career History *Include position, organization, city/state and years for each position. Please list in chronological order, ending with current position.
Career-Related Activitiese.g. consulting, current directorships
Creative Workse.g. books, journals, patents
Organizational ActivitiesPlease list civil, political or social activities. Include nominee's role, the organization name, city/state and years for each activity.
Military RecordPlease include nominee's highest rank and branch of service.
Awards/Honors/GrantsInclude award name, granting body, city/state and years for each entry.
Professional MembershipsPlease include organization name and positions held for each entry.

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