Alumni Award Nomination

Nominee Name*First Name & Last Name

Nominee Address

Nominee Phone

Nominee Email

Nominee field of study

Graduation Year

Campus Attended

McCook

North Platte

Broken Bow

Imperial

Ogallala

Valentine

Current Job Title

Employer

Nominee Contact Information

Professional Achievements*

Community Service Activities

Support and promotion of Mid-Plains Community College, McCook College Foundation and/or North Platte Community College Foundation

Additional Comments

Nominator Information

Nominator Name

Nominator Address

Nominator Phone

Nominator Email

Notified Nominee

Yes

No

I have notified the nominee of this nomination

I am an alum

Yes

No

Please send letters of recommendation to alumni@mpcc.edu