Nominator Information
 
Name:
Email Address:
Phone Number:
   
Nominee Information
   
Name:
Mailing Address
City:
State:
Zip Code:
   
Collegiate Career 
   
School:
Graduation Year:
Sport(s) Played:
Years Played:
Varsity Letters:
   
Team Accomplishments: Team records, conference championships, NCAA championship appearances, etc.
 
Individual Athletic Accomplishments: All-conference awards and level of award (1st-team All-UAA, NCAC Player of the Year, etc.), national awards and level of award (1st-team All-American, 2nd-team all-region, etc.), department awards (Hoza Award, Nip Heim Award, etc.)
 
Individual Academic Accomplishments: Academic All-American, Academic All-UAA, scholar-athlete, etc.
 
Campus Activities: Fraternities, sororities, student government, service organizations, etc.
 
   
Postgraduate Career
Addtional Education: List institution, level of degree and year
 
Postgraduate Athletic Achievements:
Working Career: Positions held, companies, years, current position, retired, etc.
 
   
Additional Information:
  Any additional information about collegiate or postgraduate career that you would like taken into consideration