William & Allene Gutherie Van Meter Outstanding Alumni Achievement Award Nomination Form
The Award is presented at the annual Donor Appreciation Luncheon. The criteria for the award are as follows:

• Nominee must be living
• Nominee would ideally be 50 years of age or younger
• Nominee must be a graduate of Labette Community College
• Nominee must have made significant professional and community service achievements
• Nominations are accepted throughout the year and should be received by August 1st for consideration for the current year.

After completing this form, please press the Submit button to e-mail your nomination to the LCC Alumni Association. Or if you prefer, you may type or write your answers on plain paper and mail to:

LCC Alumni Association
200 South 14th Street
Parsons, KS 67357

If you have questions, please e-mail Lindi Forbes at lindif@labette.edu, or telephone the LCC Alumni Association at (620) 820-1212.

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Title
First Name
MI
Last Name
Maiden Name
Address
City
State
Zip
Age
Daytime Phone
Email
Spouse's Name
Name of Child
Age of Child
Name of Child
Age of Child
Name of Child
Age of Child
Name of Child
Age of Child
Colleges & Universities Attended
Degree(s) and Year(s) Received
Employer & Location
Job Title/Assignment
Previous Employers (include dates, company name, location, title and assignment)
Memberships & Offices (including professional, religious and civic organizations)
Community Activities:
Books or Articles Published
Military Service & Responsibilities
Other information you wish to share about the nominee
Nominator's Name
Nominator's Address
Nominator's City
Nominator's State
Nominator's Zip Code
Nominator's Daytime Phone
Nominator's Email
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