Nomination Form

Nominee

First Name: _____________________________

Last Name:  _____________________________
                                               
Address: ________________________________________________________  

Phone Number:  ________________________

E-Mail Address:    ________________________

Date Submitted: ________________________

If nominee is deceased, please provide a name, address, phone number or email address for a family member or other contact person.

High School and Year of Graduation: _______________________________________

College and Year of Graduation: ___________________________________________

On a separate typewritten page, list the significant accomplishments of the nominee, both as a Rockland County high school athlete or otherwise. Be as specific as possible. Include varsity letters earned, honors won (County, Section, State, etc.), records set, times/heights/distances, post-high school achievements, dates, etc.

If available, please submit a clear black-and-white or color photo (head shot) of the nominee.

Nominating Person

First Name: ________________________________

Last Name: _________________________________

Address: ___________________________________________________________

Phone Number: _________________________

E-Mail Address: _________________________


Please Submit to:  Jamie Kempton
                              Chairman, Rockland County T&F Hall of Fame
                              55 Prospect St.
                              Nanuet, NY 10954