Fields with asterisks (*) are required.
Nominee Information
First name
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Last name
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Email
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Preferred Phone
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Address
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WSU School of Medicine Graduation Year
*
Nominator Information
First Name
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Last Name
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Are you a WSU SOM Graduate?
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Yes
No
If yes, what is your year of graduation?
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Email
*
Preferred Phone
*
Nomination Statement
Tell us why the person you are nominating should be added to the Notable Alumni List. Please be as specific and substantive as possible. If nominees meet the criteria, the Office of Alumni Affairs will contact them directly.
*