Nominee Information:

Nominee's Full Name	*
Nominee's Address	*
Nominee's Day Phone	*
Nominee's Evening Phone	*
Nominee's E-mail Address
Nominee's Cell Phone
Nominee's Date of Birth	*
Nominee's Degrees Earned at Howard University	*	Please enter the school, degree and year.

Submitter Information:

Full Name	*
Address	*
Day Phone	*
Evening Phone	*
E-mail Address	*

Questions:

1) Has your nominee consented to be nominated and agreed to serve if elected? *
Yes No

2) Is your nominee a full-time employee of Howard University? *
Yes No

Statements/Documents:

Statement explaining why the nominee will be an asset to the Board of Trustees: *
(Up to 500 words)

Biographical information: *
(Up to 500 words)