Name of Nominee :

Title:

Institution:

Telephone:

Email:

# of Years in Student Affairs :

Why should the Nominee receive this Honor? Please provide information regarding the Nominee's employment history, honors received, and impact on students, his/her institution, and the profession. Please provide as many reasons as possible.

Reason 1

Reason 2

Reason 3

Reason 4

Reason 5

Nominator's Name :

Address:

Telephone:

Relationship to Nominee:

The Diamond Honoree Program is a fund raising initiative of the ACPA Foundation. Those selected for recognition must understand and be willing to have money raised in their name. A campaign is expected to raise a minimum of $1,500. Please indicate below that you agree to serve as the Campaign Coordinator for this Honoree and that you understand that your goal is to raise a minimum of $1,500.

I agree to serve as the Campaign Coordinator for this Honoree and understand that I am expected to raise a minimum of $1,500 in honor of my nominee.

Please review the information entered above and print the form before submitting.

** If you would like to mail in the form, simply print the form with the information entered above and mail to:
Dr. Joanne Risacher, 1425 Spillan Road, Yellow Springs, OH 45387.