Download DOC Nomination Form - Southern Local School District

SOUTHERN LOCAL SCHOOL DISTRICT
2018 HALL OF FAME
OFFICIAL NOMINATION FORM
Due back to Southern High School Principal by Thursday, January 11, 2018
Nominee
_____________________________________________________________________________________
First Name /Nickname
Middle
Last
Date Submitted: ____________________________________________________________
Circle Appropriate Category:
Medicine and Science
Business and Professional
Arts and Entertainment
Humanitarian and Service
Lifetime Recognition
Contributor/Community Member
Date of Birth: _____________________________
Athlete and/or Coach
Indicate if deceased: ____
Place of Birth: _________________________________________________________________________
High School: __________________________________________________________________________
City: ________________________________________________________________________________
Name of Spouse or Closest Living Relative:
Name:
____________________________________________________________________________
Address:
Phone:
____________________________________________________________________________
___________________________________________________________________
List: Sport(s), Activity or Contributions in which nominee was involved:
_____________________________________________________________________________________
Individual Submitting Nomination Information
Name: ________________________________________________________________________________
Relationship to Nominee (Relative, professional colleague friend, etc...)
______________________________________________________________________________________
Address: ______________________________________________________________________________
City, State, Zip: ________________________________________________________________________
Telephone Number: _____________________________________________________________________
Signature: _____________________________________________________________________________
Date Submitted: ________________________________________________________________________
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Instructions
1. Complete all requested information in printed or typewritten form.
2. Include letters of recommendation, limited to one typewritten page.
3. Submit a current black-and-white photo of nominee.
4. If applicable, submit a black-and-white photo of the nominee during the period of time in which he/she was
involved in the category.
5. A limited number of newspaper clippings, magazine articles or other supportive materials also may be attached.
6. The form, the letters and photos will be retained by the Southern Local School District Hall of Fame.
General Criteria
1. The nominee must have been involved with the Southern Local School District in the category for which he or she
is nominated.
2. The nominee must have demonstrated outstanding abilities and contributions in the category for which nominated.
3. The nominee must have demonstrated high moral character, outstanding citizenship and ideals .
Specific Criteria
The following definitions and criteria shall apply to the seven nominating categories. There are no quotas for any
category.
Medicine and Science – graduates who are surgeons, specialists, and/or general practitioners of high regard or
distinction; scientists whose findings have benefited humanity in an important area of existence or who have added
substantially to the body of human knowledge; recipients of distinguished awards in any field of scientific endeavor;
etc.
Business and Professional – graduates who are respected economists, influential stock market analysts, CEOs of
noted corporations or businesses, particularly successful business persons, legal professionals, etc.
Arts and Entertainment – graduates who are well-known or frequently published writers, winners of prestigious
literary, acting or artistic awards; influential critics; recognized musicians or composers; media celebrities; etc.
Humanitarian and Service – graduates who have rendered consistent and significant service to the local, state,
national or world communities.
Athletics – graduates who are all-Americans, Olympians, or all-star professional athletes; renowned or especially
successful coaches, sports specialists, sports promoters; etc.
Athlete/High School Achievement- Any high school athlete who participated in high school athletics and
whose primary achievement in the field of athletics occurred during such high school participation.
Athlete/Post High School Contribution- Any athlete who participated in high school athletics and whose
primary contribution to athletics occurred after his or her high school career.
Lifetime Recognition – This category is reserved for an individual who may not have attained award status in his or
her chosen field but whose life demonstrates high moral character and dignity, or who has demonstrated courage in
overcoming extraordinary obstacles in life.
Contributor/Community Member- A person who has contributed to the Southern Local School
District/Community in a capacity other than the above-mentioned categories. A contributor might be an individual
who has who has served the district and students by volunteering their time and resources or working in the
community to promote the school district. Or any individual who has made significant contributions to the Southern
Local School District.
EDUCATIONAL BACKGROUND
Name of Institution
City, State
Years
Degree
High School:
_____________________________________________________________________________________
College:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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ACHIEVEMENTS, CONTRIBUTIONS & HONORS
This is where you make your point in support of the nomination. List objective, statistical records in an activity,
such as won-lost records, titles, points scored, career facts, and highlights. In the case of non-athletes/coaches, list
contributions as a speaker, writer, innovator or any other achievement which causes this person to be a candidate.
List the year and achievements, from high school through post-high school if appropriate or compile your own list
on a separate sheet. You are to focus on the nominee's contributions which had the most significant impact on the
Southern Local School District.
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