OUTSTANDING ALUMNI ACHIEVEMENT AWARD NOMINEE'S BIOGRAPHICAL INFORMATION (* mandatory) NAME*: ________________________________________________________________________ CURRENT ADDRESS*: _______________________________________________________ _______________________________________________________ _______________________________________________________ EMAIL*: _______________________________________________________ ID No. _______________________________________________________ TELEPHONE (fixed line): ____________________________________________________ MOBILE: ______________________________________________________________________ DATE OF BIRTH: _____________________________________________________________ PLACE OF BIRTH: ____________________________________________________________ EDUCATION including University of Malta Degree/s: _________________________________________________________________________________ CURRENT OCCUPATION or last occupation before retirement: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Nominators are asked to fill in as much information as is available to them. NOMINATOR DETAILS NAME: ________________________________________________________________________ UNIVERSITY OF MALTA QUALIFICATIONS (and year of last graduation) and/or POSITION AT THE UNIVERSITY OF MALTA or (if student) PRESENT COURSE: _________________________________________________________________________________ CURRENT ADDRESS: _______________________________________________________ _______________________________________________________ _______________________________________________________ EMAIL: _______________________________________________________ ID No. _______________________________________________________ TELEPHONE (fixed line): ____________________________________________________ MOBILE: Nominator undertakes to keep the nomination confidential and that s/he will make every effort to ensure that the other persons involved will do the same. Signed: Block Capitals: _______________________________________ _____________________________________ Date: _______________________________________