Hall of Fame Nomination Form

CHSCA HALL OF FAME NOMINATON

 

  1. Personal Information

Nominee’s Name: ____________________________________________________________

                                  (Last)                                                        (First)                                            (Middle)

 

Name (as it should appear on award:______________________________________________

 

Home Address: _______________________________________________________________

                                                   (Street and number)

 

City:____________________________________  State_____________________  Zip:____________

 

 

Home Phone:________________________________ Cell: ___________________________________

 

Email addres:________________________________________________________________________

 

  1. Coaching Tenure: ONLY positions held as a Varsity High School Head Coach

DATES

SCHOOL

CITY/STATE

SPORT

TOTAL YEARS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                

  1. TOTAL COACHING CAREER

    TOTAL YEARS AS A VARSITY HEAD COACH IN YOUR MAJOR SPORT: ____________

    TOTAL YEARS AS A VARSITY HIGH SCHOOL HEAD CAOCH IN ALL SPORTS:________

  2. VARSITY HIGH SCHOOL HEAD COACH RECORD

    TOTAL GAMES/MATCHES/MEETS__________________

    WINS:________ LOSSES:________ TIES:________ WIN%:________

    (NOMINEE’S NAME:_______________________________________________)

  3. TEAM CHAMPIOSNHIP INFORMATION

    THIS SECTION IS FOR YOU TO INDICATE YOUR COACHING HISTORY WITH RESPECT TO STATE CHAMPIONSHIPS. DO NOT LIST ANY RUNNER –UP INFORMATION UNLESS IT IS A STATE RUNNER-UP.

  1. STATE CHAMPIONSHIP

TOTAL

YEARS

 

  1. STATE RUNNER-UP

TOTAL

YEARS

 

  1. STATE SEMI-FINALS

 

TOTAL

YEARS

  1. STATE QUARTER-FINALS

 

TOTAL

YEARS

  1. LEAGUE/DIVISION CHAMPIONSHIPS

 

TOTAL

YEARS

  1. OTHER CHAMPIONSHIP

 

TOTAL

YEARS

 

  1. HIGH SCHOOL COACHING HONORS

    HONORS RECEIVED AS A RESULT OF YOUR WORK AS A VARSITY HIGH SCHOOL HEAD COACH (COACH OF THE YEAR. ALL-STAR COACH, ETC.)

DATE

ORGANIZATION

HONOR/AWARD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. PROFESSIONAL HIGH SCHOOL ATHLETIC ASSOCIATION SERVICE: LIST ANY HIGH SCHOOL ORGANIZATIONAL LEADERSHIP ROLE AT THE LOCAL, STATE OR NATIONAL LEVEL LIST OFFICE/POSITION HELD, COMMITTEE ASSIGNMENTS, CHAIR POSITIONS, ETC.

DATE

ORGANIZATION

POSITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(NOMINEE’S NAME:_______________________________________________)

  1. ADDITIONAL DATA OR INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICIAL CERTIFICATION OF INFORMATION

 

NOMINEE: I CERTIFY THAT THE INFORMATION DISCLOSED HEREIN IS CORRECT.

 

DATE:________________________

 

 

SIGNATURE:______________________________________________________________

 

ATHLETIC DIRECTOR OR PRINCIPAL (IF NOMINEE IS DECEASED THIS SIGNATURE IS SUFFICIENT)

 

DATE:________________________

 

 

SIGNATURE:______________________________________________________________

 

 

 

 

 

(NOMINEE’S NAME:_______________________________________________)

 

  • COPY AND PASTE INFORMATION ABOVE AND MAIL FORM TO:

 

KEN KEZER, 47 OWANECO TRAIL, OLD SAYBROOK, CT 06475