<h2>Distinguished Alumni</h2> <h3>Nomination Ballot</h3> <form name="Distinguished Alumnus" method="post" enctype="text/plain" action="mailto:adunham@siue.edu?subject=*Distinguished Alumnus Nomination"> <table width="495" border="0"> <tr> <td> </td> </tr> <tr> <td colspan="2" class="textbodybolda"><br /> Nominator’s Information</td> </tr> <tr> <td width="207" align="right" class="text1">Name</td> <td width="278"><input name="NAME" type="text" id="NAME" size="30" maxlength="30" /> </td> </tr> <tr> <td align="right" class="text1">Phone Number</td> <td><input name="PHONE" type="text" id="PHONE" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Address</td> <td><input name="ADDRESS" type="text" id="ADDRESS" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">E-mail</td> <td><input name="EMAIL" type="text" id="EMAIL" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Graduation Year (s)</td> <td><input name="YEAR GRADUATED" type="text" id="YEAR GRADUATED" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Major(s)</td> <td><input name="MAJOR" type="text" id="MAJOR" size="30" maxlength="30" /></td> </tr> <tr> <td colspan="2" class="textbodybolda">Nominee’s Information</td> </tr> <tr> <td align="right" class="text1">Name</td> <td><input name="ALUMNUS NAME" type="text" id="ALUMNUS NAME" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Address (if known)</td> <td><input name="ALUMNUS ADDRESS" type="text" id="ALUMNUS ADDRESS" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">City/State/Zip</td> <td><input name="ALUMNUS CITY" type="text" id="ALUMNUS CITY" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Home phone<br /> (if known)</td> <td><input name="ALUMNUS PHONE" type="text" id="ALUMNUS PHONE" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Work phone<br /> (if known)</td> <td><input name="ALUMNUS WORK PHONE" type="text" id="ALUMNUS WORK PHONE" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Employed by</td> <td><input name="EMPLOYED" type="text" id="EMPLOYED" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Position</td> <td><input name="POSITION" type="text" id="POSITION" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Graduation Year(s)</td> <td><input name="YEAR GRADUATED" type="text" id="YEAR GRADUATED" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">SIUE Degree(s)</td> <td><input name="SIUE DEGREE" type="text" id="SIUE DEGREE" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Other Degrees<br /> (if known)</td> <td><input name="OTHER DEGREE" type="text" id="OTHER DEGREE" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">E-mail (if known)</td> <td><input name="ALUMNUS EMAIL" type="text" id="ALUMNUS EMAIL" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" valign="top" class="text1">Description of why you think this individual is a Distinguished Alumnus/a</td> <td><textarea name="SPECIAL" cols="30" rows="10" id="SPECIAL"> </textarea></td> </tr> <tr> <td align="right" valign="top" class="text1">Describe the special characteristics, career highlights, honors and awards, personal and professional<br /> achievements, organization leadership<br /> and community involvement.</td> <td><textarea name="DESCRIPTION" cols="30" rows="10" id="DESCRIPTION"> </textarea></td> </tr> <tr> <td colspan="2" class="textbodybolda">Whom may we contact for more information about your nominee?</td> </tr> <tr> <td align="right" class="text1">Name</td> <td><input name="CONTACT NAME" type="text" id="CONTACT NAME" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Home Phone</td> <td><input name="CONTACT PHONE" type="text" id="CONTACT PHONE" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Work Phone</td> <td><input name="CONTACT WORK PHONE" type="text" id="CONTACT WORK PHONE" size="30" maxlength="30" /></td> </tr> <tr> <td align="right" class="text1">Email</td> <td><input name="CONTACT EMAIL" type="text" id="CONTACT EMAIL" size="30" maxlength="30" /></td> </tr> <tr> <td colspan="2" align="center" valign="top" class="text1"><input type="submit" name="Submit" value="Submit" /> <input type="reset" name="reset" value="Reset" /></td> </tr> </table> </form>