ALUMNI WALL OF FAME NOMINATION FORM
Alumni Awards will be given to select Leyden alumni. Selections will be made on the basis of the following criteria:

1. Graduated from Leyden at least ten years ago;

2. Has achieved at an outstanding level in his/her field and has made significant contributions to that field; and

3. Exhibits outstanding leadership, character, and service.

I wish to nominate the following person for an ALUMNI AWARD:

NAME:
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HOME ADDRESS:
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CITY, STATE, ZIP:
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EMAIL ADDRESS:
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PHONE NUMBER:
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POSITION:
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YEAR OF GRADUATION:
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WHICH CAMPUS?
NOMINATION SUBMITTED BY:
Please give your name and contact information.
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Please list below the nominee's contributions and achievements in his/her profession and community.
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