THE BROWSER WILL TIMEOUT AFTER 10 MINUTES OF INACTIVITY. IN ORDER TO KEEP THE AN ACTIVE SESSION, PLEASE INTERACT WITH THE BROWSER FREQUENTLY. IF YOU ARE UNABLE TO COMPLETE THE FORM IN 10 MINUTES, PLEASE STORE YOUR RESPONSES OUTSIDE OF THE PLATFORM UNTIL YOU ARE READY TO SUBMIT.
NOMINATORS DO NOT NEED TO BE GEORGIA TECH GRADUATES, IF NOMINATORS ARE AFFILIATED WITH GT, WE'D LOVE YOU TO INCLUDE THAT INFORMATION.
IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL, THE SUBMISSION WAS NOT RECEIVED.

Nominator First Name

Nominator Last name

Email Address

Nominator Address:

Country:

Address Line 1:

Address Line 2:

City:

State:

ZIP Code:

Nominator Phone Number:

US/CanadaOther Country

Example: 402-555-1212

GT Major:

GT Preferred Year (Example: 1965):

Relationship to Nominee: