Please return this Nomination Form to:
Nominee:_____________________________________________________________________ Class:________
Address:____________________________________________________________________________________
City:______________________________________________________________State:________ZIP:_______
Daytime telephone:_______________________ Evening telephone:_______________________
Email:______________________________________________________________________________________
Norwich degree and major:______________________________________Corps or civilian:__________
Sports, activities, clubs at Norwich:____________________________________________________________________________________
Other degrees/universities/specialties:_____________________________________________________
Spouse (including maiden name):_______________________________________________NU/VC?________
Children (names & ages):____________________________________________________________________
Any children attend/graduate from NU/VC?____________________________________________________________________
Current employer & job title (if retired, previous profession):_____________ ___________________________________
Nominated by:_____________________________________________Class:_______Date:__________________
Please give a brief description of the nominee's alumni or other volunteer involvement:
____________________________________________________________________________________
____________________________________________________________________________________
Describe the nominee's professional/military/civil career highlights/experience: (if necessary use reverse side):
____________________________________________________________________________________
____________________________________________________________________________________