TCNAA HALL OF FAME NOMINATION FORM *Please answer each question completely, resumes cannot be accepted in lieu of completing this form.* Do not close browser prior to completing and submitting this form as it cannot be saved. Doing so will cause all data to be lost and unrecoverable. I. Nominating Body (check one) Required Chapter Self Other Name of Person/Chapter Submitting Nomination Address City State Zip Code ** Phone Number Contact Person Contact Email Address II. Information on Nominee Name Home Address City State Zip Code Phone Number Nominee Email Address Profession Company/Organization Title Business Address City State Zip Code Year of Graduation or Departure from Tougaloo Attended: (Check all that apply) Tougaloo Preparatory School Tougaloo Southern Christian Institute Tougaloo College Degree(s) Earned/Areas of Concentration Other Educational Institutions Attended III. Biographical & Background InformationA. Category of Nomination - Check One *(Required) Arts and Entertainment Athletics Business Communications Community Service Education Government and Law Medicine Religion Science B. Reason for nomination in appropriate category C. Nominee's Professional Accomplishments D. Professional Certification E. Education & Training F. Professional Affiliations G. Nominee's Financial/In-kind Contributions to Tougaloo H. Publications: I. Leadership Skills: J. Alumni Association Participation: K. Community Service: SUBMIT