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home » the alumni » alumni achievement award - nomination form
Alumni Achievement Award - Nomination Form
( *All fields are required )

Nominations due by 1 May 2007
(Nominations accepted from IMU Alumni and IMU Staff only)

Nominator Information:
Nominator Name
(you can nominate yourself)
Degree / Batch
Daytime Telephone
Evening Telephone
Email
   
Nominee Information:
Nominee Name
Degree / Batch
Occupation
Current Employment Title
Organisation
Address Type
Home Office
Address
Daytime Telephone
Evening Telephone
   
Please describe how the nominee meets the criteria and
why you feel this nominee should receive an award:
       

 
(Feel free to send supporting materials such as the nominee’s CV or
a list of referees to

If you have any questions, please contact Charmaine Khoo:
Ms Charmaine Khoo
Alumni Office
Department of Student Affairs
IMU
Plaze Komanwel
Bukit Jalil 57000
Kuala Lumpur
Phone: 03-86567273
Fax: 03-86561018
 
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