Name of Nominee: *

Years Played (if known):

Sport(s):

Letters Earned (if known):

Position(s) on team:

Team Captain :

No Yes

Current Address: (Street)

City/St./Zip

Occupation:

Company:

Academic Major & Academic Honors at UofS:

Individual Statistical Highlights & Awards (stats, all-conference, all-America honors, etc.)

List Any Professional Sports Experience (name of teams, years, awards, highlights, honors:

List Any Civic, Community Service and/or Professional Awards or Achievements:

Name: *

Date:

E-Mail: *