Please provide the following information:
 

Name:  

Street Address:

City:

State/Province:   Zip/Postal Code:

Phone:  

E-mail address:

YEARS OF FULL-TIME SERVICE AT CCRI DATE OF RETIREMENT:

Date of Retirement:

Contributions
In the space below, describe your contributions to the college during your tenure. Please
be specific and include dates, if possible. You should include the following:

Awards
Honors
Achievements
Course or curriculum development
Starting a new program or activity
Innovating, improving, or extending an existing program or activity
Any work advising students in their clubs or other extra-curricular activities
Any grants or other resources that you may have secured
Any work that you may have done on behalf of CCRI with an outside group
Committee service, including college-wide, divisional, or departmental committees

Be as complete as possible.

Please submit by September 30