HOF Nomination Form

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Individual Submitting Nomination: *

Nominator's Phone Number: *

Nominator's Email Address: *

Full Name of Nominee: (please include maiden name if applicable) *

Please Choose One Category for the Nominee: *

Student-Athlete Team Coach Contributor

Nominee's Phone Number: *

Nominee's Email Address:

Nominee's Present Employment:

For Support Purposes Please Provide A Personal: (spouse, partner, parent) or Professional Contact on Behalf of the Nominee (email, phone#, or address)

If Former Athlete, Years of Attendance/Participation at Kirkwood:

Athletic Participation at Kirkwood or Contribution to Kirkwood Athletics: (Please give supporting details concerning athletic career including sport(s), Records, Statistics, etc. or Specific Contributions)

Honors Received: (Please give complete details of college and post-college honors, awards and recognitions received as a result of achievements: i.e. All-American, All-Conference, Championships, National Player of the Year, etc.)

Professional Affiliations and Achievements:

Email address *

* required field