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CCSHOF Nomination Form

First Name

Email

Sport or Position

Born in PA

Yes

No

Retired from sport at least (3) years

Yes

No

Over the age of 55

Yes

No

Last Name

Phone

Participant

Coach

Official

Contributor

Played in Centre County

Yes

No

Where in Centre County?

Been in sport or position (25) years

Yes

No

Willing to attend Induction Ceremony

Yes

No

Living

Yes

No

Deceased for at least (1) year

Yes

No

Person ever convicted of a Felony

Yes

No

Biographical Sketch of Nominee.

Thanks for you nomination! We look forward to reviewing the submission!

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