Date of Nomination ... *

Nominee Full Name *

Home Address

Phone Number *

Email Address *

Year Graduated *

Nominated By

Home Address

Phone Number

Email Address *

Nomination for induction (check all that apply) Athlete Coach Athletic Director Team Booster/Benefactor *

Nominee's athletic accomplishments during or after graduation/employment *

If nomiated as a Booster/Benefactor, Coach, or Athletic Director, provide a brief description of individuals contributions

Why should this individual or team be considered?

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