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Alumni Award Nomination Form

* designates required field

Nominee information

*First name
*Last name
Maiden name
*Graduation year
*Address
*City
*State
*Zip code
*Home phone
Business phone
*Email address
*Occupation
*Employer

Submitter information

Name
Daytime phone

Award applying for

Select one Distinguished Alumnus/Alumna Award
Alumni Service Award
Graduate of the Last Decade (GOLD)
*Please state why this alumnus should be considered for this award

Please submit all supplementary materials to: Office of Alumni Relations, Virginia Wesleyan College, 1584 Wesleyan Dr., Norfolk, VA, 23502

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