Athletic Hall of Fame Nomination Form

Name of Nominee
Name of Nominee Name of Nominee First Last
Phone Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
If nominating a team – list team members:
Amateur Status

List schools attended
High School
College
Honors Received
State
National
International
Professional Status
Teams' Played/Managed/Coached:
Team's City/Sponsor
Awards Received
Additional Information to Support Nomination