Alumni Board Nomination Form

Alumni Board
Nomination Form


Nominator Information
First Name
required
Middle Name
Last Name
required
Maiden Name
Address 1
required
Address 2
City
required
State
required
Zip
required
Phone Number
required
Cell Phone
Class Year
Major
Does nominee have prior knowledge of this nomination?

required
Nominee Information
First Name
required
Middle Name:
required
Last Name
required
Maiden Name:
Primary E-mail
Address 1:
required
Address 2:
City:
required
State:
required
Zip:
required
E-mail
required
Phone Number:
Cell Phone
Class Year:
Major
required
Current Occupation
Spouse First Name:
Spouse Last Name:
Spouse Class Year (if attended Arkansas Tech)
Children
Affiliation(s) while a student at Arkansas Tech (student organizations, athletics, groups, etc.)
required
Affiliation(s) with Arkansas Tech since graduation (alumni/university, Clubs, athletics, etc.)
required
What interestes do you have for becoming an Alumni Board Member?
required
Click the "Submit" button below to complete nomination. You will receive an email confirmation after submitting.