Nomination Form

Nomination Form

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Nominator's Contact Information
Name:
Email Address:
Confirm Email:
Phone (Home):
Phone (Business):
Is this a self-nomination? Yes No
Relationship with Nominee:
Nominee's Contact Information
Name:
Email Address:
Confirm Email:
Phone (Home):

Diploma/Degree from Fisheries and Marine Institute of Memorial University of Newfoundland:
Year(s) of graduation:
Other Academic degrees, honors and distinctions:
Current work position/occupation:
Explain in detail the nominee's exceptional accomplishments in both their professional achievements and/or service to society?
And why are the nominee's accomplishments considered exceptional?
How does the nominee inspire others with the values and ethics that guide their life and career?
Describe how the nominee is involved with the Fisheries and Marine Institute of Memorial University of Newfoundland?
Please upload any additional supporting documentation. Valid file types: Microsoft Word (.doc, .docx) Microsfot Excel (.xls, xlsx) Microsoft PowerPoint (.ppt, .pptx) Images (.jpg, .gif, .png, .bmp) Adobe PDF (.pdf) Rich Text Format (.rtf) Open Document Format (.odf)

⇛ Drop files to upload (or click) ⇚

Privacy Statement

Memorial University of Newfoundland protects your privacy and maintains the confidentiality of your personal information. The information requested in this form is collected under the general authority under the Access to Information and Protection of Privacy Act, 2015, SNL2015 CHAPTER A-1.2.

Information collected will be stored with Development and Engagement and in the Alumni Affairs and Development database and may be used for event planning, fundraising, income tax purposes, statistical reporting and affinity partnerships. If you have any questions about the collection and use of your information, please contact the Development and Engagement Office at 1-709-778-0367 or 1-709-778-0621 or alumni@mi.mun.ca

Fisheries and Marine Institute of Memorial University of Newfoundland

Nomination Form

Nominator's Contact Information

Nominee's Contact Information

Privacy Statement