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Individual Submitting Nomination: *
Nominator's Phone Number: *
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Full Name of Nominee: *
Please choose one of the following category for the Nominee: *
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If Retired, Date of Retirement:
Nominee's Spouse of Closest Living Relative, with Address and Phone Number:
If Former Athlete, Years of Attendance/Participation at Kirkwood:
Athletic Participation at Kirkwood or Contribution to Kirkwood Athletics: (Please give details concerning athletic career including sport(s). Records, Statistics, etc. or Specific Contributions)
Honors Won: (Please give complete details of college and post-college honors, awards and recognitions received as a result of achievements: i.e. All-American, All-Conference, Championships, National Player of the Year, etc.)
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