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
Does nominee have prior knowledge of this nomination?

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)
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.