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Panther Prowl Jan 09 MINE.pmd - Elyria Catholic High School

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Hall of Fame Nomination Form<br />

Elyria Catholic Alumni Association Hall of Fame Award Nomination Form<br />

Please circle the award for which you are nominating somebody:<br />

Distinguished Alumni Outstanding Educator Exceptional Service<br />

Please complete the Nomination Form and send along with as much information on the nominee as possible (i.e.<br />

resume, letters of recommendation, newspaper articles, etc.).<br />

Name of Nominee: ________________________________________________ Maiden: _______________________________<br />

Year of ECHS Graduation (if applicable): _________________<br />

Home Address: _____________________________________________City: ___________________State: ____ Zip: _______<br />

Home Phone: _____________________________ E-mail: _______________________________________________________<br />

Education: College or University ____________________________________________________________________________<br />

Year graduated: ______________ Degree: ___________________________________________________________________<br />

Honors or Awards:_______________________________________________________________________________________<br />

Career/Professional<br />

Career/Profession: _______________________________________________________________________________________<br />

Years of Service: ___________________________ Position: _____________________________________________________<br />

Honors or Awards: _______________________________________________________________________________________<br />

Community/Public Service – list nominee’s community and public service activities:__________________________________<br />

_______________________________________________________________________________________________________<br />

_______________________________________________________________________________________________________<br />

Please answer the following question using specific details that support the criteria mentioned above. Please use the reverse<br />

side of this page if necessary and write legibly. Attaching handwritten or typed pages is appropriate.<br />

Why do you believe this individual should be selected for recognition with an ECHS Hall of Fame Award? Please include any<br />

relevant facts, figures, job descriptions, special honors, contributions, years of service, or any other information that will be of<br />

assistance to the selection committee:<br />

_______________________________________________________________________________________________________<br />

_______________________________________________________________________________________________________<br />

_______________________________________________________________________________________________________<br />

_______________________________________________________________________________________________________<br />

_______________________________________________________________________________________________________<br />

_______________________________________________________________________________________________________<br />

Nominator Information:<br />

Name: ______________________________________________________________<br />

Address: _______________________________________________________________________________<br />

City, State, Zip: ______________________________________________<br />

Home Address: _____________________________________________City: ___________________State: ____ Zip: _______<br />

Home Phone: _____________________________ E-mail: ______________________________________________________<br />

Cell Phone: _________________________________________________<br />

This nomination will be kept on file for five years for consideration. Any new information added to a nominees’<br />

file in subsequent years will start the time frame over again.<br />

Mail To:<br />

ECHS Development Office<br />

725 Gulf Road<br />

Elyria, OH 44035

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