Nomination Form

To nominate yourself or a classmate to be a Council member, fill out and submit the following Barnes-Jewish Alumni Advisory Council Nomination Form. Contact Dr. June Cowell-Oates at [email protected] or 314.454.8694 with any questions about the form or the nomination process.

Please submit any nomination forms for the Alumni Advisory Council today.

* = Required fields

Name

Address

City, State, Zip

Phone

School Attended

Degree

Class Year

Current Position/Title

Please select your top three areas of interest

Past or Current Involvement with your Legacy Educational Institution