3. Are you an annual financial contributor to the Alcorn University Foundation? Yes No 4. Please specify other financial contributions you have made to Alcorn State University, whether it be through your local chapter, individual or otherwise. 5. What other organization are you affiliated with in your community? 6. What national organizations/associations are you affiliated with? 7. What committees do you currently serve on in your local alumni chapter? 8. What committees have you served on within the last five (5) years in your local alumni chapter? 9. What committee(s) do you presently serve on with the national alumni association? 10. What committees have you served on within the last five (5) years in the national alumni association? 11. What efforts have you made to increase membership locally and nationally? 12. What fundraising efforts for the Alcorn State University Foundation have you participated in? Information about person nominating and completing this form: Name: Email Address: Mailing Address: Telephone: _________________________________________ _______________________ Signature of Nominee Date _________________________________________ _______________________ Chapter President Signature Date Submit electronically to: February 1st Nomination Deadline:
3. Are you an annual financial contributor to the Alcorn University Foundation? Yes No 4. Please specify other financial contributions you have made to Alcorn State University, whether it be through your local chapter, individual or otherwise. 5. What other organization are you affiliated with in your community? 6. What national organizations/associations are you affiliated with? 7. What committees do you currently serve on in your local alumni chapter? 8. What committees have you served on within the last five (5) years in your local alumni chapter? 9. What committee(s) do you presently serve on with the national alumni association? 10. What committees have you served on within the last five (5) years in the national alumni association? 11. What efforts have you made to increase membership locally and nationally? 12. What fundraising efforts for the Alcorn State University Foundation have you participated in? Information about person nominating and completing this form: Name: Email Address: Mailing Address: Telephone: _________________________________________ _______________________ Signature of Nominee Date _________________________________________ _______________________ Chapter President Signature Date Submit electronically to: Nomination Deadline: February 1st