Request for Campus Memorial Plaque

Current employees who die while employed by CNM and deceased former CNM employees are commemorated on the Campus Memorial.

The name of an employee who dies while in service at CNM is placed on the memorial at no charge pursuant to the submission of this form based on the verification of the deceased's CNM employment.

Please refer to the Employee Handbook for detailed information. 

(as you wish it to appear)
Please provide the start and end years the employee worked for CNM (i.e. 2005 - 2010).
What position(s) did the individual hold at CNM?