Online Scholarship Software provided by WizeHive
     
  Nominee Form 2011  
     
  Athlete's Information  
  Athlete's Name:*  
  Sport:*  
  Height:* ex: 5.8  
  Age:*  
  Address:*  
  City:*  
  State:*  
  Zip Code:*  
  Phone(Home/Cell):*  
  Phone(Work/School):  
  Email:*  
  Vocation of Nominee :*
  If Student, List School :  
  Upload the picture: (JPG, GIF)  
       
 

  Parent's Information  
  Parents Name:*  
  Address:*  
  City:*  
  State:*  
  Zip Code:*  
  Phone(Home/Cell):*  
  Email:*  
       
 

  Coaches Information  
  Coaches Names :*  
  Primary Contact:*  
  Address:*  
  City:*  
  State:*  
  Zip Code:*  
  Phone(Work):*  
  Phone(Cell):  
  Email:*  
       
 

  Your Information  
  Person Submitting Nomination :*  
  Address:*  
  City:*  
  State:*  
  Zip Code:*  
  Phone(Home/Cell):*  
  Fax:  
  Email:*  
  Connection with Nominee :*  
       
Please complete this form with as much information as you have available.

  Please list all outstanding performances and/or records achieved during 2011 at national and international competitions.(Include name of the event, date and results). Do not include information data prior to 2011.*  
   
     
  List the athlete's single most important accomplishment in 2011.*  
   
     
  Describe other athletic accomplishments in 2011 that support the nominee's recognition.*  
   
     
  In the space below state why this nominee deserves recognition as the nation's outstanding amateur athlete based on the qualities of leadership, character, sportsmanship, and his/her accomplishments in the world of sport. The qualities are not limited to inside the lines of the competition, but should be evident in his/her lifestyle as a whole.*  
   
  Does athlete receive compensation for appearance in respective sport?*  
   
  If yes, please explain.    
   
       
     
Please complete this form with as much information as you have available.