Music Hall of Fame Nomination Form

Music Hall of Fame Nomination Form
I would like to nominate the following person for an Iowa Lakes Community College Music Hall of Fame Award
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Nominee is an Iowa Lakes Alumni *

Yes No I'm not sure
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Email Address *
example@example.com
Four individuals will be inducted to the Music Hall of Fame in the categories listed below. Please answer the following four questions as you’re able. You do NOT have to fill in all the categories. Share as many details as you can.
1. Impact growth or development of the Iowa Lakes Music Department: *
2. Influenced the work of musicians, music lovers or society at large: *
3. Utilize originality of creativity to establish new standards: *
4. Involvement and commitment to Iowa Lakes Music Department: *
Please include professional achievements and/or accomplishments: *
Share examples of community leadership, service, etc: *
Include any other information you’d like to share with the selection committee about this nominee: *
Your First Name *
Your Last Name *
Your Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Your Phone Number (include area code) *
Please enter a valid phone number.
Your Email Address *
example@example.com
Should be Empty: