Distinguished Alumni Application Form

The Distinguished Alumni Award was established by the Southeastern Community College Alumni Association to recognize and honor an alumna/us of SCC or its predecessor colleges, Burlington Junior College, Burlington Community College, and Keokuk Community College, who has achieved substantial public recognition for their accomplishments or success. To be eligible for nomination, the nominee should have:

1. Earned 30 credit hours at Southeastern Community College or was considered a full-time student for two semesters, and

2. Earned the respect and trust of his/her associates in his/her chosen field, or

3. Made substantial contributions to the good of his/her fellow human beings or be recognized as an outstanding practitioner of his/her profession or vocation, or

4. Served as a motivational force for others in a positive manner.

I would like to nominate the following person for the Southeastern Community College Distinguished Alumni Award:

Nominee's Name*

First NameLast Name

Nominee's Class Year*

Campus Attended*

Nominee's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Nominee's Phone Number*

Please enter a valid phone number.

Nominee's Email Address*

example@example.com

Your comments on this nomination need not be confined to this form. Please be complete but concise, responding to as many categories as you believe apply to the nominee. Please provide any additional information you feel may be pertinent to this nomination.

Professional achievements/accomplishments*

Contributions to the betterment of the community, region, state or nation:*

Examples of community leadership, service, philanthropy, etc.:*

Additional comments you would like to make in support of your nomination:*

Your Name*

First NameLast Name

Your Email Address*

example@example.com

Your Phone Number*

Please enter a valid phone number.

Nomination for Distinguished Alumni Award