Alumni Board Interest Form

Alumni Board of Directors Interest Form

Interested in becoming involved in the NEOMED Alumni Association Board of Directors or have a fellow alumnus/a in mind who would be a good representative?

Name*

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First

Last

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Phone*

Phone number is collected in case the committee has questions or needs additional information.
Email*

Email address is collected in case the committee has questions or needs additional information.
Nominee*

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First

Last

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Does this individual know he or she is being nominated?*
- Yes
- No
Please list the areas in which the nominee serves NEOMED and our students:*
Briefly describe why the nominee is deserving of the Distinguished Service Award:*
Upload Nominee CV
Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Not required but you may choose to include.
Upload Letter of Recommendation
Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Not required but you may choose to include.
Upload References
Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Not required but you may choose to include.
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Email

This field is for validation purposes and should be left unchanged.