LBPS: Hall of Fame
ACADEMIC HALL OF FAME
 
 
To better assist you in completing the form,
please refer to the form required checklist below
before completing the online nomination form.
When you are ready t
o submit your nomination, 
you must fill out the online form linked above. 
 
FORM CHECKLIST:
 
PLEASE PROVIDE
TWO LETTERS OF RECOMMENDATION
WITH YOUR SUBMISSION
 
 
-BASIC INFORMATION-
 
                              -Nominee's Name:
                              -Nominee's Address:
                              -Nominee's Phone Number:
                              -Nominee's LBPS Graduation Year:
 
-ACADEMIC CONTRIBUTIONS CATEGORY-
(Pick One or More)
 
                              -Medicine and/or Science
                              -Business
                              -Humanities
                              -Humanitarian and/or Service
                              -Lifetime Recognition
                              -Other
 
-NOMINEE BIOGRAPHICAL INFORMATION-
 
Education Background:
(Post High School experiences, colleges, degree(s) 
special courses or training, certifications)
 
 
Career Background:
(Name of employers, job titles with
 brief description, years employed)
 
Community Involvement:
(All community, civic, committees or
organizations of which nominee is a member.
Include any titles or posts held, past or present)
 
Awards/ Honors:
(List all and include why bestowed, 
years bestowed and bestower)
 
Accomplishments:
(Nominee's most 
rewarding accomplishments)
 
Quote:
(Choose one quote that you feel 
best reflects nominee's philosophy)
 
 
 
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