Athletic Hall of Fame Nomination Form

Nominee Information:
First Name:  
Middle/Maiden Name:
Last Name:  
Class Year:
Current Address:  
City:  
State:   Zip:  
Daytime Phone:
Evening Phone:
Home Email:  
Office Email:
Birth Date:
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:
# of letters:
Years as captain:
Individual Honors:
School Records:
Team Honors:
 
Sport:
Years played:
# 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 you contribute or have contributed your time and talent. Please include any titles (i.e. president, chairperson) if applicable.
Post College Athletic Achievements:
Please provide any additional information: