New Jersey Lacrosse Hall of Fame

Columbia High School Athletic Hall of Fame Nominee Questionnaire

Instructions: Please complete and return to: Email: [email protected]

Nominee’s Name (as they would like it to appear on award) ______Submission Date:______Address:______City: ______State:______Zip:______Phone numbers (H)______(W) ______(M) ______Email address:______Sport or Sport(s) you would like to be inducted for: ______

Education High School______Years Attended: ______College______Years Attended: ______Post Grad______Years Attended: ______Playing Experience High School______Years: ______Position: ______College______Years: ______Position: ______Club ______Years: ______Position: ______International or Pro: ______Years: ______Position: ______Other: ______Years: ______Position: ______Coaching: (Circle Head or Assistant) High School ______Years: ______Position: H A College ______Years: ______Position: H A Club ______Years: ______Position: H A International or Pro: ______Years: ______Position: H A Other: ______Years: ______Position: H A Officiating: Officials Association: Date: High School ______Years: ______College______Years: ______Club______Years: ______

HONORS – TEAM – Was the Nominee Ever – A) On a High School Championship Team(s) as a Player: ______Coach: ______TEAM: ______League: ______YEAR: ______B) On a National Collegiate Championship Team(s) as a Player: ______Coach: ______TEAM: ______DIVISION: ______YEAR: ______C) On a Club Championship Team(s) as a Player: ______Coach: ______TEAM: ______League: ______YEAR: ______D) On an international or professional Championship Team(s) as a Player: ______Coach: ______TEAM: ______League: ______YEAR: ______HONORS – INDIVIDUAL – Was the Nominee Ever – A) Selected on a High School All-Selection Team Team: ______YEAR: ______B) Selected on a High School All-American Team Team: ______YEAR: ______C) Selected on a College All-Conference Team Team: ______YEAR: ______D) Selected on a College All-American Team Team: ______YEAR: ______E) Selected on an All Star Team:(North/South, USA Team,) Team: ______YEAR: ______F) Selected as Coach of the Year Team: ______YEAR: ______G) Other Honors (List with Dates) ______

Offices held in any athletic Organizations (with dates) ______Chair of any other local committees (with dates): ______Other contributions in your sport: ______Any other Honors – Athletic or Non-Athletic: ______Please feel free to attach any other relevant material (letters, newspaper articles, stats)

APPLICATION SUBMITTED BY:

Name: ______Address:______City: ______State: ______Zip______Best time and phone number to contact: ______Email address: ______