Alumni Board nominations form

The following Allisonians are eligible for nominations:

Any person who has received a degree, diploma, or certificate from MtA.
Any person who was registered in a program leading to a degree, diploma, or certificate from 69��˵�Ӱ�� University.
All present and former members of the administrative and teaching staff at MtA.
All Mount A honorary degree recipients and all present and former members of the Board of Regents of the University.
Those individuals who have shown a commitment to MtA.

Before you begin to fill in this form, make sure you have the candidate's:

* Indicates required field

Candidate name *

Class year *

Home address

Address

Address 2

City/Town

Province/State

Postal Code/ZIP

Country

Phone number *

E-mail *

Current professional/career activity *

Current volunteer activities *

Activities at MtA when a student *

Please explain why you believe this candidate would make a good Alumni Board member *

Yes

Name

Phone number

E-mail

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