Athletic Hall of Fame Nomination Form

General Information

Name *

First

Last

Name while at The Valley (if different from above)

Class Year

Current Address *

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Daytime Phone Number

###

####

Evening Phone Number

###

####

Email Address *

Office Email Address

Date of Birth

YYYY

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

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

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 Achievements

Please provide any additional information

Nominator Information