For a downloadable PDF Nomination Form that can be filled out by hand and mailed in, click here

Nominee Information

Select Eligibility Category: *

Full name: *

Phone: *

Email: *

Street Address: *

City,State Zip Code: *

Date of Birth: *

Birthplace: *



If deceased, name and address of nearest living relative:


High School: *

College/University:


Current Employment:



If Category A, please list nominees Special Achievements/Awards with School Attended, Year Award was received, Sport, Grade Level, and Head Coach.
List each achievement/award on separate lines.



Any additional significant information (Civic and Community Service):




If Category B, please list nominees Special Achievements/Awards with School/Team, Position, Year(s), Sport, and Level.
List each achievement/award on separate lines.



Any additional significant information (Civic and Community Service):







Nominator Information


Full name: *

Phone: *

Email: *


Street: *

City, State Zip Code: *




Mailing Address (if different from above)

Street:

City, State Zip Code:





Why do you feel this person should be considered for the Florence Athletic Hall of Fame? *