Nomination Hall of Fame & Alumnus Award

Nominee Information:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
If the nominee is a graduate of ETSU, what year was the last degree conferred?
What was the degree and program?
[Note: All CCRSH/COPAH graduates will be considered by the selection committee for both the Distinguished Alumni Award and the Hall of Fame Award.]
Nominator Information:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
In addition to this cover sheet, each nomination may include the following items.

A document listing the monimee's accomplishments

Letters of support (not to exceed two pages)

A current vita or resume for the nominee (if available - limit 5 pages)
List of nominee's accomplishments

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A current vita or resume for the nominee

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Letters of support

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Should be Empty: