Hall of Fame Nomination Form

NOMINEE INFORMATION

Date *

Month

Day

Year

Nominee Full Name *

Is nominee a graduate of ULM (formerly NLU/NLSC) College of Pharmacy? *

Yes

If yes, which one? *

Degree (if known)

Class year (if known)

Is the nominee living or deceased *

Living

Deceased

If deceased, can you provide contact person (name and email or phone number) for notification of nomination. *

Company/Business/Title for nominee *

Tell us a little bit about the nominee’s work history/background *

Why does this person deserve to be in the College of Pharmacy Hall of Fame? (show distinction and deservedness) *

NOMINEE CONTACT INFORMATION

Mailing Address

State *

City *

Zip *

Work or Home *

Home

Work

Email *

NOMINATED BY

Full Name *

Relationship to nominee *

Email *

Day phone *

Complete online form by June 15, 2025. If you would like to submit an additional letter of nomination, biographical data, or any other supporting documentation (no more than 3 pages of supporting documentation), please email to Katie at kkelley@ulm.edu or mail to the address below by June 15, 2025.

Attn: Katie Scogin
ULM College of Pharmacy
1800 Bienville Dr.
Monroe, LA 71201

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