Nomination Form

Date:                                  

Coaches Category                          Athletic Category                                  Special Category

Name of Nominee:                                                                                                     Class of:                                           

Address:                                                                                                                                                                                   

City:                                                                                  State:                                                 Zip Code:                           

Home Phone:                                                  Cell Phone:                                        Email:                                                                                                                                                                                                                                                   

Varsity Sport(s) Played:                                                                                                                                                      

Year(s) Varsity Letter Earned:                                                                                                                                             

Sport 1:                                                                                           Sport 2:                                                                           

Sport 3:                                                                                           Honors:                                                                           

Name and Relationship of Nominator:                                                                                                                          

Address:                                                                                                                                                                                   

City:                                                                                  State:                                                 Zip Code:                           

Home Phone:                                                  Cell Phone:                                        Email:                                                

                                                                                                                                                                                                  

Seconded by (Name and Relationship, may be a relative to 2nd):                                                                                                                                                                                                                                                               

Outstanding High School Accomplishments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             

Collegiate and/or Professional Athletic Accomplishments:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             

Community or Professional Involvement:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            

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