LC Distinguished Alum Nomination

Full Name of Nominee *

Maiden Name

(if applicable)

Phone Number *

Home Address *

City, State, Zip Code *

Email Address *

Year of Graduation *

Degree Earned

Personal Information

Spouse's Name

Children's Names

Grandchildren's Names

Career Information

Civic, Social, and Religious Involvement

Awards, Recognitions, and Publications

Additional Degrees or Education

Full Name *

Home Address *

City, State, Zip Code *

Home Telephone *

Business/Cell Phone