BUSINESS PHONE. CELL PHONE. OTHER: ... Owner, John Walters Photography. 1979. 1991 ... District Manager, Government &
Alumni Award
2013 NOMINATION NOMINATIONFORM FORM 2010 UC Clermont College 2013 Distinguished Alumnus Nomination Form In 2013, UC Clermont College is proud to recognize one outstanding alumnus of this institution. To be eligible, an individual should have distinguished themselves through professional accomplishment, have been involved in their community through volunteer work and have attended Clermont College at least one year. If you wish to nominate someone please: FOLLOW THESE 3 STEPS
Please complete this form along with a separate sheet with your answers to the required award information (see page 2) and submit it by Monday, February 11, 2013.
STEP 1 NAME OF NOMINEE:
FIRST
MIDDLE
MAIDEN
HOME PHONE
BUSINESS PHONE
CELL PHONE
LAST
MAILING ADDRESS:
CITY / STATE / ZIP:
CONTACT INFO:
E-MAIL ADDRESS
OTHER:
MAJOR
GRAD YEAR OR YEARS ATTENDED UC CLERMONT
OTHER EDUCATION
OCCUPATION/EMPLOYER
STEP 2 NOMINATOR’S NAME: FIRST
MIDDLE
MAIDEN
BUSINESS PHONE
CELL PHONE
LAST
MAILING ADDRESS:
CITY / STATE / ZIP:
CONTACT INFO:
HOME PHONE
E-MAIL ADDRESS
RELATIONSHIP TO NOMINEE:
OTHER:
GRAD YEAR OR YEARS ATTENDED UC (IF ALUMNUS OF UC)
PLEASE SEND COMPLETED APPLICATION, LETTER OF RECOMMENDATION AND ANY OTHER SUPPORTING MATERIALS TO:
Dana Parker • UC Clermont College • 4200 Clermont College Drive • Batavia, OH 45103 • or e-mail:
[email protected] • 513-558-9964
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Alumni Alumni Award Award
2013 NOMINATIONFORM FORM 2013 NOMINATION NOMINATION 2010 FORM UC Clermont College
STEP 3
Please submit a comprehensive of recommendation with thisNomination application. Below is a checklist of information required for 2013letter Distinguished Alumnus Form the award:
In UC Clermont is proud to recognize one outstanding alumnus of this institution. To be eligible, UC2013, Clermont College College Distinguished Alumnus an should through professional accomplishment, have been involved individual Indicate how long, have and indistinguished what capacity, themselves you have known the nominee. in their community through volunteer work and have attended Clermont College at least one year. If you wish Describe the nominee’s notable accomplishments in his/her profession. to someone please: nominate Illustrate the nominee’s sig contributions to society.
Provide spe 3 examples FOLLOW THESE STEPS of the personal qualities that make this nominee stand out.
Attach any this otherform references or evidence to sheet support the nomination, the award nominee’s resume or employment Please complete along with a separate with your answers toincluding the required information (see page 2) and history if possible. submit it by Monday, February 11, 2013.
STEP 1 NAME OF NOMINEE:
Year
UC Clermont College Outstanding Alumni FIRST
Recipient
MIDDLE
MAIDEN
LAST
Title
Graduation Year
MAILING ADDRESS:
1990
Owner, John Walters Photography Clermont County Auditor Clermont County Commissioner 1992 1993 Prevention Specialist/Psychologist CONTACT INFO: BUSINESS PHONE CELL PHONE 1994 School Teacher, Oyler Elementary 1995 Executive Director, The Literacy E-MAIL ADDRESS Council of Clermont & Brown Counties 1996 John M. Thompson Flight Commander, Pilot/Instructor – USAF OTHER: MAJOR McIntosh GRAD YEAR OR YEARS ATTENDED UC CLERMONT 1997 Jimmi Supervisor of Adult Education, Clermont County OTHER EDUCATION Debra Carter Baker 1998 CoordinatorOCCUPATION/EMPLOYER of Family & Children First 1999 Marjorie Holbrook STEP 20002 Lindsay Danahy Professor Emeritus, Clermont College 2001 Associate Veterinary Surgeon 2002 Dr. Shakuri David CardiologistMAIDEN NOMINATOR’S NAME: FIRST MIDDLE LAST CITY / STATE / ZIP: 1991
2003 2004 2005 2008 CITY / STATE / ZIP:
John Walters Linda Fraley Robert Proud Nona Waters HOME PHONE Judith Gatch Susan Vilardo
Development Coordinator, Chatfield College Milford City Manager Teacher, West Clermont School District Andy McCreanor Executive Director/CEO, Executive Service Corps of Cincinnati 2009 Cara Hannah Sullivan Hairdresser, Saturday Night Live CONTACT INFO: HOME PHONE BUSINESS PHONE CELL PHONE 2010 Richard Krieger Plant Manager, Sun Chemical 2011 Warren Walker District Manager, Government & Community E-MAIL ADDRESS Relations, Duke Energy 2012 Dr. M.E. Steele-Pierce Asst. Superintendent, West Clermont Schools RELATIONSHIP TO NOMINEE: MAILING ADDRESS:
OTHER:
Nan J. McCart Loretta E. Rokey
1979 1982 1978 1988 1979 1975 1980 1978 1993 1986 1976 1978 Attended 1978-1979 1992 1995 1989 Attended 1980-1981 1997 1975 1992 1982
GRAD YEAR OR YEARS ATTENDED UC (IF ALUMNUS OF UC)
PLEASESEND SENDCOMPLETED COMPLETEDAPPLICATION, APPLICATION,LETTER LETTEROF OFRECOMMENDATION RECOMMENDATIONAND ANDANY ANYOTHER OTHERSUPPORTING SUPPORTINGMATERIALS MATERIALSTO: TO: PLEASE
Dana ParkerDelaney • UC Clermont CollegeCollege • 4200•Clermont CollegeCollege Drive •Drive Batavia, OH 45103 • or e-mail:
[email protected] • 513-558-9964 Meredith • UC Clermont 4200 Clermont • Batavia, OH 45103 • or e-mail:
[email protected] • 513-558-9964
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