Athletic Hall of Fame Nomination Form

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LVC Athletic Hall of Fame Nomination Form

Nominee Full Name *

First

Last

Name while at The Valley (if different from above)

Class year

Current address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Daytime phone number

Evening phone number

Email Address *

Office email address

Date of birth

Place of birth

Deceased?

Education

College

Graduation year

Major

College

Graduation year

Major

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

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Community Involvement

Please describe any organizations or groups to which this person contributes or have contributed his/her time and talent. Please include any titles (I.E. President, Chairperson) if applicable.

Post college athletic achievements

Please provide any additional information

Nominator Information

Nominator Full name

First

Last

Nominator Email address