Application: BCNAA

BCNAABenedict College National Alumni Association

Alumni Award Nominating Application

Name of person completing this application:
Last   First MI
Address:
City: State/Province:
Zip Code:   Country:
Phone Number: Home Work
E-mail Address:


Has this Nominee been contacted? (If no, please do not proceed with this application)

Name of Nominee:
Last   First MI

Address:
City: State/Province:
Zip Code:   Country:
Phone Number: Home Work
E-mail Address:

Spouse's Name:
Class Year: - Sex: - Date of Birth: (Date Format: MM/DD/YYYY, MM = Month, DD = Day of Month and YYYY = Year)


THIS AWARD APPLICANT IS BEING NOMINATED FOR THE FOLLOWING AWARD(S):


Distinguished Service (Alumnus) Award
Outstanding Achievement Award
Distinguished Service (Non-Alumnus) Award
Young Alumni Service Award - 25 to 35 years of age
Pre-Alumni Service Award - Benedict College Student
Other:

EDUCATION:
(School, Degrees, & Date Awarded)

EMPLOYMENT DATA:
(Employer, Address, Position Held, & Dates)

BENEDICT COLLEGE AFFILIATIONS, SERVICE AND ACHIEVEMENTS:

MEMBERSHIP:

Alumni Association Status: Inactive, Date Joined: (Date Format: MM/DD/YYYY, MM = Month, DD = Day of Month and YYYY = Year)

Local Alumni Chapter:

CIVIC AND COMMUNITY CONTRIBUTIONS, SERVICE, ACHIEVEMENTS:

FINANCIAL CONTRIBUTIONS:

Current (Amt. and Date): , Past (Amt. and Date):

REFERENCES:
(At least three who are members of the BCNAA)


Submit Completed Form To:
Office of Alumni Relations and Advancement Services
Award Application
1600 Harden Street
Columbia, SC 29204 or Fax to: 803-705-6654 (Fax)
Email: jacqueline.williams@benedict.edu

Deadline: February 28th

NOTE:
The Committee is not responsible for verifying credentials of nominees as College records may not exist. It is strongly advised that nominees submit all credentials for the application to be fully considered. Bio and Photo are required to complete this application. Incomplete Application will not be considered.