LVC Athletic Hall of Fame Candidate 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

Preferred Phone Number

###

####

Preferred Phone Type

Cell

Home

Work

Preferred Email Address *

Education

College

Graduation Year

Major

Post-Undergraduate Institution (if applicable)

Graduation Year

Degree Received

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 you contribute or have contributed time and talent. Please include any titles (I.E. President, Chairperson) if applicable.

Post College Athletic Achievements

Please provide any additional information

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