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Board of Governors Nomination Form

NOMINEE INFORMATION
First Name:
Last Name:
Middle Initial:
Home Address:
Telephone
Fax:
Email Address:
Class Year or Year(s) Attended the University of Maryland:
Major(s):
Degree(s):
Education other than at University of Maryland:
Business/Profession:
Title:
Business Address:
Business Telephone:
Fax:
ACTIVITIES
Current University of Maryland Activities:
University of Maryland Activities as a Student:
*Business, Professional, Community Service, Honors, Awards or Achievements:
Please include any more information that may be helpful to the Nominating Committee:
If you prefer to upload a file, please make sure it is no more than 5MB.  



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University of Maryland Alumni Association • Samuel Riggs IV Alumni Center
College Park, MD 20742-1521 • 301.405.4678 • 800.336.8627
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