1.  Name the one faculty or staff member who had a positive impact on your college experience. 

     Prefix (Dr./Ms./Mr./Mrs.):  

     First Name:  

     Last Name:  

2.  How did this individual enhance your NIU experience?  (Please provide a concise, detailed explanation.)

3.  Your contact information:

Your Name:          

E-mail address:   

Phone number:  

You may share my information with the person I've nominated.

Yes
No

    Note: Deadline for submission is Sunday, November 15, 2009.