Nominee First Name 
Nominee Last Name 
Nominee Address   City 
State   Zip 
Nominee Home Phone   Work   
Cell   E-mail Address   
Nominee Sports Played, Coached, or Supported 
Nominee Noteworthy Statistical Data, Honors, Awards, Leadership, etc

Nominee Additional supporting information (accomplishments away from the college, personal success, etc) 

Individual Name submitting Nominee 
Individual Contact e-mail submitting Nominee