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SIUE Alumni Hall of Fame Nomination Form

Nominee Information

Full Name
Home Address
City
State
ZIP
Best Phone
Email
Year of graduation or last year attended SIUE
Major/Degree
Nominating for School/Unit ...*
Degrees earned other than at SIUE
Professional Title
Business Name
Company Website
Nomination Statement (fewer than 300 words)
Professional Activities
Special Contributions/Achievements
Nominee’s involvement with SIUE after graduating
Civic/Community Involvement
Please share why you believe your nominee has made an impact at SIUE and worthy of this award. Be sure to include supporting details about their professional/personal activities, contributions and involvement with SIUE students, community and others.
Additional Information/Comments

Nominator Information

Once you submit this form, a response page will appear with a link you can use to email supporting documents if you choose.