CALS College and
Alumni and Friends Society Awards Nomination Form
Please
fill in the information requested, detach form and attach your
statement of
contributions (and any other supporting information). Please
photocopy
the form to nominate more than one candidate. Nominations will be
accepted by mail, fax, or email at the addresses below
no later
than July 28.
NOMINEE
INFORMATION
Name:________________________________________________________________________
Address:
______________________________________________________________________
______________________________________________________________________________
Telephone:
____________________________________________________________________
Fax:__________________________________________________________________________
E-Mail :
_______________________________________________________________________
Employer:______________________________________________________________________
Position
Held:___________________________________________________________________
Employer’s
website:______________________________________________________________
Category of
award:
o
Distinguished Alumnus
o
Outstanding
Alumnus
o
Outstanding Young Alumnus
o
Outstanding Faculty/Staff
o
Outstanding Friend
NOMINATOR
INFORMATION
Name:________________________________________________________________________
Address:
______________________________________________________________________
E-mail
Address:_________________________________________________________________
Daytime
Phone:_________________________________________________________________
Relationship to
Nominee:__________________________________________________________
Send form to:
W. Scott Troutman, Executive Director
CALS Alumni and Friends Society
Campus Box 7601
Raleigh, NC 27695
email: scott_troutman@ncsu.edu
Or fax to:
(919) 515-5274