PROFESSIONAL MEMBERSHIP - NOMINATION FORM

	KAPPA OMICRON NU PROFESSIONAL MEMBERSHIP
		    Nomination Form


This nomination form, typed or printed, should be submitted to 
the campus or alumni chapter executive committee or to 
	Kappa Omicron Nu, 4990 Northwind Dr., Ste. 140, 
	East Lansing, MI  48823-5031.

1.	_________________________________________________________
	Proposed Member (First, Middle Initial, Last)	Date

	_________________________________________________________
	Business Address (Street)

	__________________________________________(   )__________
	(City, State, ZIP Code)				Telephone

	_________________________________________________________
	Home Address (Street)

	__________________________________________(   )__________
	(City, State, ZIP Code)				Telephone

	_________________________________________________________
	e-mail Address

2.	Academic Record:

College/University	Dates		Degree		GPA

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

3.	Professional positions:
						Major
Position	Name of Employer	Dates	Responsibilities

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

4.	Honors and Awards:














5.	Professional Activities--membership in honor societies 
	and professional organizations, including professional 
	involvement in community organizations--give evidence of
	involvement--offices, committees, etc.:









6.	Endorsement and documentation of commitment to the goals 
	of Kappa Omicron Nu by Nominator:






7.	Name of two persons who will submit letters of 
	recommendation and documentation of contribution to the 
	profession:





______________________________________________________________
Signature of Nominator				Date

END OF DOCUMENT