Address _________________________________________________________________________________
________________________________________Telephone________________________________________
High School Awards________________________________________________________________________
(All-Valley, All-County, All-State, etc.)
_________________________________________________________________________________________
College Awards ___________________________________________________________________________
(Capt. of Team, All-American, etc.)
_________________________________________________________________________________________
Professional Teams and Awards ______________________________________________________________
(Awards, All-Pro, etc.)
________________________________________________________________________________________
Recreational Achievements __________________________________________________________________
(Awards, National/State championships, etc.)
_________________________________________________________________________________________
Short Biographical Background _______________________________________________________________
(Additional Information not listed above)
_________________________________________________________________________________________
If person is nominated, would he/she be available for the awards ceremony? Yes_____ No ______
Is person alive or deceased?_____________ Would there be a photograph available?_____________________
This nomination submitted by_________________________________________________________________
Address__________________________________________________________________________________
Telephone________________________________________________________________________________
Yes, you may contact me for a video recorded testimonial regarding the work and impact of the nominees achievements.
Other contacts who may provide testimonial support include:
Name_____________________________________ Phone_______________________________________
Name_____________________________________ Phone_______________________________________
NOTE: Attach additional sheets if necessary