Harmon Memorial Wall - Application

please read the rules & regulations before completing the application below

click to download and print an application

Application (Revised July 2018)

Contact Information

I have read the Rules and Regulations

Yes

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Home Phone*

Cell Phone*

Email*

Individual to be Added to the Harmon Wall

Full Name*

Class Year/ Affiliation*

Military Branch

Highest Rank

Biography

Please fill out the following information. If selected for placement on the Wall, this will be used to prepare a program and remarks for the Harmon Memorial Wall Ceremony.

Deceased Date*

Hometown

Degree

Norwich involvement (clubs, sports) while a student at Norwich

Career

Survived by*

Other information we should know

Service Experience

Service on one or more of the University boards or organizations (minimum of 10 years)

Board of Trustees - Years of Service

NU Alumni Association (NUAA) - Years of Service

Partridge Society Board - Years of Service

Board of Fellows - Years of Service

Cemetery Association Board - Years of Service

Regional Club Leadership - Years of Service

Admissions Ambassadors - Years of Service

Class Agent - Years of Service

Other - Please include years of service

Faculty years of service

Staff years of service

Achieved Partridge Society Two-Star Level ($100,000)

Yes

Unknown

Military Service

Cost

A gift of $2,500 is required to put a name on the Harmon Wall. This gift is used for student scholarships and for perpetual maintenance of the site.

I will be mailing a check, made payable to Norwich University.

Please charge my card if this application is approved.

Enter the amount your check will be made out for, or how much you would like to charge to your card.*

Name on Card

Card number

Card type

Expiration Date

Security Code

By checking this box, you are giving Norwich permission to charge your card in the amount listed above. This will act as your signature.

Please Note

This application deadline is August 1 of each year to be considered for the wall that same year. All applications will be reviewed by the Harmon Wall Committee and appropriate parties will be notified of committee decisions.

Norwich University | Alumni & Family

Harmon Memorial Wall Application

Application (Revised July 2018)