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Alumni Awards Nomination Form

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Here is your chance to nominate Ivy Tech alumni in recognition of their personal and professional achievements and life-long dedication to Ivy Tech Community College.

Please nominate any person you believe would be a deserving nominee. The deadline to submit nomination materials is May 15.

There are two ways you can submit your nomination.  Either please fill out the pdf form or submit your form on the online form below. (Please note, if you submit your nomination form online,  LETTERS OF RECOMMENDATION (NO MORE THAN THREE) WILL NEED TO BE SENT SEPARATELY. PLEASE SEND TO CHRIS HANCOCK, EXECUTIVE DIRECTOR OF ALUMNI RELATIONS, 50 W.FALL CREEK PKWY NORTH DR., INDIANAPOLIS, IN 46208-5253. PLEASE REFERENCE IN YOUR MAILING WHICH SUBMISSION THE REFERENCE LETTERS REFER TO.)

Here is your chance to nominate Ivy Tech alumni in recognition of their personal and professional achievements and life-long dedication to Ivy Tech Community College. Please nominate any person you believe would be a deserving nominee

* indicates field is required

*Nominee's Name:

Maiden Name:

*Date of Birth

*Mailing Address:

*City and State:

*Zip:

Home Phone:

Cell Phone:

Email Address:

*Present Occupation (title, company, profession, etc.)

*Year of Graduation

*Campus:
Northwest Region
South Bend
Fort Wayne
Lafayette
Kokomo
Muncie
Terre Haute
Central Indiana
Richmond
Columbus
Lawrenceburg
Evansville
Sellersburg
Bloomington

*Program of Study:

*Degree(s):
Associate of Arts Degree
Associate of Science Degree
Associate of Applied Science Degree
Technical Certificate

Marital Status:
Married
Not Married

Name of Spouse:

Did Spouse attend Ivy Tech?
Yes
No

*Relationship to Nominee:

*Mailing Address:

*City, State and Zip:

*Home Phone:

Cell Phone:

Email Address:

*Please explain why this nominee should be selected for the Alumni Achievement Awards:

*Please complete the biographical data below: Attendance at other colleges/universities (school, years, major, degree), Career since leaving Ivy Tech Community College (employer, position, years, title), Professional and Civic Organization Membership, Awards and Honors, Professional/Community Service, Continued association with Ivy Tech Community College, What do you consider your most important achievement(s)?, Additional comments, Letters of recommendation (no more than three)

Form created by Form Forge. Contact chancock21@ivytech.edu for assistance.
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