Hall of Fame Application

Email Secondary Email

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Nominee Name: *

Email address *

Nominee Employer: *

Nominee Address: *

Nominee Phone number: *

Category (Choose One): *

List sport(s) nominee played/coached/administered/supported (if applciable) and the number of years involved with the particular program(s):

List nominee's special contributions/accomplishments during his/her years at North Country Community College:

Please provide a summary of why you feel this person(s) should be considered for the North Country Community College Hall of Fame: *

List Contacts who can provide additional information if need be. Please provide names, addresses, email and phone numbers for each contact.:

Name of person making nomination: *

Adress of person making nomination: *

Phone & Email of person making nomination: *

Date nomination is being submitted: *

* required field