Nomination for The

NOMINATION FOR THE DISTINGUISHED ALUMNI AWARD

The inaugural Distinguished Alumni Award is the highest honor given to alumni by Iowa Central Community College, Eagle Grove Junior College, Webster City Junior College and Fort Dodge Junior College. This award honors Iowa Central alumni who are nationally and/or internationally recognized for preeminent contributions to their professions and/or community. Up to five awards will be granted annually. (Current members of the faculty, staff, board of directors, and award committee members are ineligible to receive this award.)

[PLEASE TYPE] Name Home address Home phone Cell Phone Business name (or Profession/Life’s Work) Business address Position title Daytime phone E-mail Fax Degree(s) earned from ICCC (list degree/curriculum/year)

Degree(s) earned from other institutions (list degree/curriculum/year/institution)

SELECTION CRITERIA: Please follow the nomination format closely. Please list applicable information in each of the following categories, and attach two additional letters of recommendation. Additional attachments or information other than those requested below will not be considered in the selection process.

1. Nominator’s summary detailing why this person should be chosen for this award and the national and/or international preeminent contributions of the candidate’s life’s work, business, or profession that qualifies him/her for this award 2. A current resume and/or vitae listing relevant employment positions held; national and/or international recognitions, activities, and organizations; previous business/profession/life’s work, honors, awards or achievements; and creative work (summary of significant publications, research, patents, etc.)

Name of nominator Daytime phone Cell: E-mail Home address Business name/title Business address Signature of nominator Date

RETURN NOMINATION FORM AND SUPPORTING MATERIALS BY AUGUST 15th to: Iowa Central Alumni Association, Attn: Distinguished Awards Committee, Iowa Central Community College, One Triton Circle, Fort Dodge, IA 50501 or fax to 515-576-7207. Questions? Please call Associate V.P., of Development & Alumni Relations, Laurie Hendricks at 800-362-2793, Ext. 1145 (locally at 515-574-1145), or send e-mail to [email protected]. This information is requested to select individuals for recognition. No persons outside the college are routinely provided this information. Excerpts from the nomination and supporting letters may be used for publicity or in the printed program for award winners. (4-10-12)