John L. Imhoff Scholarship Nomination Form

To nominate a student for the John L. Imhoff Scholarship, complete this form as indicated. This scholarship is awarded to one person each year. Please forward any questions to Bonnie Cameron, headquarters operations administrator, (770) 449-0461, etc. 105, or e-mail bcameron@iienet.org.

Nominations must be received by Nov. 15.

This nomination is categorized as:

Nominee Information:

Name:

School:

Degree:

Does the nominee have a minimum cumulative GPA of 3.40 on a scale of 4.00?

City, State, Zip:

Work Phone:

Home Phone:

Fax Number (if available):

E-mail Address:

Membership Number (if applicable):

Chapter Number (if applicable):

Nominator Information:

Name:

Title:

Company/School:

Mailing Address:

City, State, Zip:

Work Phone:

Home Phone:

Fax Number (if available):

E-mail Address:

List the names and addresses of three individuals that have consented to provide professional or academic references for the nominee. Each reference must submit a letter of reference via e-mail to bcameron@iienet.org by Nov. 15.

Reference 1:

Reference 2:

Reference 3: