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Nomination Form

Please complete all form fields below to nominate a qualified ACH candidate for the James N. (Jim) Cleveland Memorial Scholarship.


Candidate Name
Candidate's Organization:
Candidate's Position:
Candidate's Phone:
Candidate's E-mail Address:
Candidate's Work Experience: (provide all related experience or be sure to mail in the nominee's resume)
Candidate's Career Goals:
Reasons For Candidate Consideration:
Your E-mail Address:
Letters of Recommendation:	Send Letters to: ALACHA - Scholarship 2 Riverchase Office Plaza, Suite 111 Birmingham, AL 35244