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