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LAS-I Nomination Form


Name
School
Major
Year in School
Dates of Active Service
(e.g. 2000-2004)
Email Address
Mailing Address
Conferences Attended
Awards received during college career:
Brief paragraph illustrating the inductee’s contributions at the campus, regional, and/or national levels (250 words max):
Submitter's Name
Submitter's Email
Enter both words correctly to prove you are human: