Athletic Hall of Fame Nomination Form


Nominee Information

General Information

*First Name: 
Middle/Maiden Name: 
*Last Name: 
Class Year:
*Current Address: 
*City: 
*State:         *Zip: 
Daytime Phone: 
Evening Phone: 
*Home Email: 
Office Email: 
Date of Birth: 
Place of Birth: 
Deceased?

Education

College:
Graduation Year:
Major:
College:
Graduation Year:
Major:

College Athletic Record

(Honors, School Records, Team Records, Captainship, etc.)
Sport:
Years Played:
Number of Letters:
Years as Captain:
Individual Honors:
School Records:
Team Honors:
Sport:
Years Played:
Number of Letters:
Years as Captain:
Individual Honors:
School Records:
Team Honors:

Occupation

Current Occupation:
Current Employer:
Employer's Address:
City: 
State:           Zip: 
Community Involvement: Please describe any organizations or groups to
which this person contributes or have contributed
his/her time and talent. Please include any titles
(i.e. president, chairperson) if applicable.
Post College Athletic Achievments:
Please provide any additional information:

Nominator Information

*Name:
*Email: