Alumni Board Nomination Form

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

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