First Name*
Last Name*
Address*
City*
State* Select your state AL - AlabamaAK - AlaskaAZ - ArizonaAR - ArkansasCA - CaliforniaCO - ColoradoCT - ConnecticutDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiID - IdahoIL - IllinoisIN - IndianaIA - IowaKS - KansasKY - KentuckyLA - LouisianaME - MaineMD - MarylandMA - MassachusettsMI - MichiganMN - MinnesotaMS - MississippiMO - MissouriMT - MontanaNE - NebraskaNV - NevadaNH - New HampshireNJ - New JerseyNM - New MexicoNY - New YorkNC - North CarolinaND - North DakotaOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVT - VermontVA - VirginiaWA - WashingtonWV - West VirginiaWI - WisconsinWY - WyomingD.C. - District of Columbia
Zip Code*
Email*
Contributions to Lake Land College Beyond Your Basic Job: (These contributions could include leadership posts within the college itself; leadership posts in recognized college organizations; curriculum or program leadership; committees chaired or leadership in committees; examples regarding “going the extra mile” for students or colleagues, and the like. Specific examples could include service as a division chair, program coordinator, LLFA officer, club advisor, chairing key components in the North Central accreditation, leadership in key committees such as curriculum, site and development, president’s advisory, negotiations, etc.) Please be specific.
Contributions to Community or Profession Beyond Lake Land College: (These contributions could be at the local, regional, state, or national levels and that reflect positively for Lake Land. Examples could include leadership in service organizations, professional organizations, church or community groups dedicated to helping others, fund raising, missionary work, etc.) Please be specific.
Awards, Honors, and Other Comments: These may relate to Lake Land College directly, or be from contributions made to local, regional, state, or national organizations. Please be specific.
Please direct any questions to Amanda Allen with any questions at 217-234-5376 or alumni@lakelandcollege.edu.