HALL OF FAME NOMINATION BALLOT .

Date Nomination Received: ______Nomination Received By: ______(for HOF use only) (for HOF use only)

Mail completed Ballot to: Lisa Reardon @ 2501 Shepherds Ridge; Poland OH 44514 Direct any questions to [email protected]

***PLEASE PRINT ALL INFORMATION LEGIBLY*** .

NOMINATION RESPECTFULLY SUBMITTED BY:

Name: ______Date Nomination submitted: ______

Address: ______

City: ______State: ______Zip Code: ______

Home Phone: (______)______Email: ______

Cell Phone: (______)______Work Phone: (______)______

***PLEASE PRINT ALL INFORMATION LEGIBLY*** . (use the back of this sheet if you need more room)

NOMINEE INFO: What year did he/she graduate from Poland Seminary High School? ______

First Name: ______Last Name (Maiden): ______

Last Name (if Married): ______Spouse's Name: ______

Children: (circle) Boy / Girl Name: ______Age: ______

(circle) Boy / Girl Name: ______Age: ______

(circle) Boy / Girl Name: ______Age: ______

Address: ______

City: ______State: ______Zip Code: ______

Home Phone: (______)______Email: ______

Cell Phone: (______)______Work Phone: (______)______

Please outline any Personal &/or Family information that you feel is relevant:

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HIGH SCHOOL PLAYING CAREER (use the back of this sheet if you need more room to list your honors): **PLEASE PRINT AND FILL OUT THIS PAGE FOR EACH ADDITIONAL SPORT**

Sport: ______How many letters did you receive in this sport? ______

Position(s) Played / Event(s): ______

Were you on a high school Championship team? If so, what year(s): ______

Were you chosen to an All-State team? If so, what year(s): ______

Were you chosen as an All-American? If so, what year(s): ______

State Honors? If so, what year(s): ______

Regional Honors? If so, what year(s): ______

District Honors? If so, what year(s): ______

Sectional Honors? If so, what year(s): ______

Did you break any record(s) in this sport? If so, please give the details (use other side if needed).

What record(s) did you break? ______

How many years had this record been held until you broke it? ______

Which record(s) still stand as of this date? ______

Did you receive any other Athletic honors for this sport that are not listed above? (list them below)

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MISCELLANEOUS: Please list any HIGH SCHOOL Scholastic honors: ______

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Please list any Personal HIGH SCHOOL achievements that are relevant: ______

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***PLEASE PRINT ALL INFORMATION LEGIBLY*** . (use the back of this sheet if you need more room to list your information)

POST HIGH SCHOOL INFORMATION:

MILITARY INFORMATION: (Branch, years in service, honors, tours of duty, rank, etc.)

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DID YOU ATTEND COLLEGE? (circle one) No Yes

What University? ______

DID YOU PLAY A SPORT AT THE COLLEGIATE LEVEL? (circle one) No Yes

SPORT: ______How many years did you play? ______

Position Played / Event(s): ______

Did you receive any collegiate letters &/or honors? (please list the correlating year as well):

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DID YOU PLAY A SECOND SPORT AT THE COLLEGIATE LEVEL? (circle one) No Yes

SPORT: ______How many years did you play? ______

Position Played / Event(s): ______

Did you receive any collegiate letters &/or honors? (please list the correlating year as well):

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