Alumni Board Nomination Form

Thank you for your interest in serving on your school's Alumni Board. Please complete the form below and submit. If you prefer a paper copy or have any questions, email alumni@umc.edu or call (601) 984-1115.

* = Required Fields

Name of Nominator*	*
Name of Board Nominee*	*
School*	School of Dentistry School of Graduate Studies School of Health Related Professions School of Medicine School of Nursing School of Population Health *
Nominee Class Year*	*
Nominee Employer/Practice Name*	*
Nominee Cell Number*	() - ******
Nominee Email Address*	*Invalid Email
Please list contributions/accomplishments of nominee in the areas of clinical service, research, education, and/or administrative leadership. Please be specific.*	*
Resume/CV	*.txt,*.doc,*.docx,*.xls,*.xlsx,*.pdf, *.gif,*.jpg,*.jpeg,*.bmp,*.png,*.tif,*.tiff