* Required

Nominee's Name:*required

Class Year:

Degree/Major:

Address:

Phone Number:

Email:

Occupation:

Employer:

LR Involvement as a Student:

LR Involvement as a Graduate:

Professional Accomplishments:

Community Involvement:

What strengths and talents would this nominee offer to the Alumni Association Board:

Nominator's Name (if not a self-nomination):

Nominator's Email (if not a self-nomination):

Nominator's Phone Number (if not a self-nomination):

If you are nominating someone else, what is your relationship to the nominee:

Please send a confirmation email to the address below*: