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Alumni & Friends

Dr. Marilyn E. Flaherty Distinguished Alumnus/a Award 2012 Nomination Form

The Dr. Marilyn E. Flaherty Distinguished Alumnus/a Award recognizes "an individual, who, upon graduation from Salem State University, has distinguished himself or herself and his or her alma mater."

Please provide as much biographical information as possible to help the screening committee with their decision. Return your completed nomination on or before March 1, 2012.

To download a PDF document of this form click here.

Nominee's Name

Class Year

Street Address

City

State

Zip Code

Telephone

Alumni		Faculty
Administration		Staff

Reasons for Nomination(s): (Remember to include detailed information about the individual nominee. Competition is intense; the more information the selection committee has to consider the better the opportunities for recognition. Please mail any supportive relevant material to this nomination.)

Reasons

Name of Person Making Nomination

Address

Telephone

Nominator is Alumni		Nominator is Faculty
Nominator is Administration		Nominator is Staff

Alumni & Friends

Dr. Marilyn E. Flaherty Distinguished Alumnus/a Award 2012 Nomination Form

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