WESTERN CONNECTICUT STATE UNIVERSITY
ATHLETIC HALL OF FAME NOMINATION FORM

Anyone can make one nomination per year. The deadline for the 2009 ceremony is April 1, 2009.
 
Complete the form below and mail to:
WCSU Alumni Office, 181 White Street, Danbury, CT 06810. Call (203) 837-8298 for more information on WCSU Athletic Hall of Fame nominations.
 

I nominate ____________________________________________________________________________________________________
 

Sport ________________________________________________________________________________________________________
 


CHECK ONE:


_______   Coach               ________       Player     _______  Support Person


Include details.... years, honors, etc.!

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

Nominator Information:

Name _______________________________________________________________________________________________________
 

Address ______________________________________________________________________________________________________
 

____________________________________________________________________________________________________________
 

Day Phone ___________________________________________________________________________________________________
 

Evening Phone ________________________________________________________________________________________________
 

E-mail address _________________________________________________________________________________________________