Part C
Please respond to the following questions by filling them in electronically or on a separate sheet
of paper(s). The selection team bases its decision on the written information provided. A
complete application should address all the categories with specific examples in each.
Please note: The completed application may not exceed 2 pages or 2000 number of words.
1. Leadership: How has the nominee exhibited outstanding leadership and character in
his/her career, community, and personal life?
2. Occupation: What is the nominee’s occupational and other noteworthy
accomplishments in his/her field?
3. Community: What service(s) and contribution(s) has the nominee made to the
community through civic, charitable, business, profession, or other means?
4. Chippewa Valley Technical College: How has the nominee given support to CVTC in
terms of time, talent, or treasure? (Examples: hiring CVTC graduates, serving on an
advisory committee, monetary or in-kind contributions, etc.)
5. Other: Please provide any other information pertinent to this award nomination.
Do you want your nominee notified via a letter he/she was nominated if he/she is not
selected as the Distinguished Alumnus?
_____ YES _____ NO
If yes, may we share your name as the nominator?
_____ YES _____ NO
Thank you for your nomination. Please return the completed nomination form to: CVTC Alumni
Association, 620 West Clairemont Avenue, Eau Claire, WI 54701. For questions, phone
715-858-1888 or email alumni@cvtc.edu.
