Amanda-Clearcreek Alumni Association Distinguished Alumni Nomination Form

Amanda-Clearcreek Alumni Association

Distinguished Alumni Nomination Form
Amanda-Clearcreek Alumni Association

P.O. Box 275

Amanda, Ohio 43102
Criteria for honorees shall include but not be limited to: success in a chosen field of employment, distinguished military service, contributions to their community, attainment of advanced education, service to humanity and the advancement of the ideals of scholarship, character, service and leadership.

You may nominate a living or deceased alumnus. Graduates from Amanda High School, Stoutsville High School or Amanda-Clearcreek High School are eligible.

The application deadline for a given year is March 31st.
BASIC INFORMATION
Nominee's Name *

First Name Last Name
Nominee's Address (if deceased, please provide a current contact person)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
If nominee is deceased, please provide the name of the contact person whose address is listed above.

First Name Last Name
Nominee's Phone Number (if applicable)

Area Code Phone Number
Nominee's E-mail (if applicable)
What year did the nominee graduate from high school? *
Name of Nominator *

First Name Last Name
Nominator's Phone Number *

Area Code Phone Number
Nominator's 2nd Phone Number

Area Code Phone Number
Please provide a brief description of the nominee's accomplishments that justify this award. Please include such criteria as organization memberships, professional or personal accomplishments, community service, military service, etc. *
Authentication *

By clicking this box, I certify that the information I have entered is correct and accurate to the best of my knowledge.
Questions? Call Carolyn Tilley at: 740-654-8363 or ctilley5455@att.net or Jeff Tilley at: 740-681-9590 or jptffa@yahoo.com
The nominator will be contacted if their nominee is selected. Recipient(s) will be recognized at the annual Amanda-Clearcreek Alumni Association banquet which will be held on the Saturday following the Amanda-Clearcreek High School graduation.
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Amanda-Clearcreek Alumni Association

BASIC INFORMATION