Wabash Valley Alumni Achievement Award

Alumni Achievement Award Nomination Form

The deadline to submit nomination materials is March 15. Click here for a print version of the form.

CRITERIA
Nominees must be graduates of Ivy Tech Community College, having received an Associate of Arts Degree, Associate of Science Degree, Associate of Applied Science Degree or a Technical Certificate. The nominee must also satisfy the following criteria and submit the following support materials:

  1. The nominee has made notable professional or personal achievements since graduation.
  2. Through leadership and/or active volunteering, the nominee has made a positive impact on his/her community and/or Ivy Tech Community College.
  3. Letters of recommendation (no more than three).
  4. High resolution (print quality) headshot photograph of the nominee.
   NOMINATOR INFORMATION: 
Nominated by:*  
Relationship to Nominee:*  
Mailing Address:*  
City/State/Zip:*  
Home Phone:*  
Cell Phone:*  
Email Address:*  

   NOMINEE INFORMATION
Nominee's Name:*  
Maiden Name:*  
Mailing Address:*  
City/State/Zip:*  
Home Phone:*  
Cell Phone:*  
Email Address:*  
Date of Birth:*  
Marital Status:*  
Name of Spouse:*   Did Spouse attend Ivy Tech?*
Yes
No
Present Occupation (title, company, profession, etc.):*  
Year of Graduation:*  
Campus:*  
Program of Study:*  
Degree(s):*

Associate of Arts Degree
Associate of Science Degree
Associate of Applied Science Degree
Technical Certificate
 

   PLEASE ANSWER THE FOLLOWING* 
Please explain why the nominee should be selected for the Alumni Achievement Award:*
Attendance at other colleges/universities (school, years, major, degree):*
Career since leaving Ivy Tech Community College (employer, position, years, title):*
Professional and Civic Organization Membership:*
Awards and Honors:*
Professional/Community Service:*
Continued association with Ivy Tech Community College:*
What do you consider to be the most important achievement(s) for the nominee?:*
Additional Comments:*