Hall of Fame Nomination Form

San Diego Chapter of US Lacrosse Hall of Fame Nominee Questionnaire

To be considered for nomination, this questionnaire must be completed by, or on behalf of, each candidate. Please attach additional information if possible.

I. Personal Data
Full Name___________________________________________________

Spouse______________________________________________________

Home Address________________________________________________

____________________________________________________________

City_______________________________State____Zip Code___________

Birth Date_____________________

Home Phone (           )__________________________________________

Business Phone (           )________________________________________

Cell Phone (            )___________________________________________

Email___________________________@__________________________

Please outline any family information that you feel is relevant. ____________________________________________________________

____________________________________________________________

Please list occupation, position held and involvement with professional organizations. ____________________________________________________________

____________________________________________________________

II.               Playing Career
Field Position_________________________________________________

Indoor Position________________________________________________

Name Location Playing Years_________

High School _________________________________________________________

College _________________________________________________________

Club _________________________________________________________

Professional _________________________________________________________

High School Honors, Championship Teams, Awards: ____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

High School All-American Teams:
School ________________________________________ Year_________

School ________________________________________ Year_________

Collegiate Honors, Championship Team, Awards: ____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

Collegiate All-American:

School ________________________________________ Year_________

School ________________________________________ Year_________

Professional Accolades:

___________________________________________________________

___________________________________________________________

___________________________________________________________

Collegiate, club, or professional all-star teams:

Team______________________________________ Year_____________________

National honors received:

Honor ____________Event_____________Location ____________Year__________

III. Coaching Career

Head Coaching Positions:

Team__________________________ Year(s) ____________ Record _____________

Assistant Coach:

Team__________________________ Year(s) ____________ Record _____________

Coaching Honors:

Honor_____________________________________ Year______________

IV. Officiating/Umpiring Career

Years served as an official/umpire:

Years_______________ Level ________________ Association____________

Years served as official/umpire for championship play?

Event______________________ Year________________ Location___________

Major assignments (NCAA, State Championships, Int’l:

Event____________________________________ Year________________

Personal honors received as an official/umpire:

Honor________________________________ Year_____________________

V. Service

Have you served in an official capacity as an officer, committee member, representative or volunteer for any recognized lacrosse organization:

Title______________________ Organization_______________ Year (s)_______

Have you started a new team, held clinics or otherwise promoted the game?

Accomplishment___________________________________ Year____________

Honors received as a contributor to the game’s growth and development:

Honor_____________________________________ Year________________

Administrative/Committee Experiences:

Committee_____________________Position Held______________ Year______

VI. Civic and Military Honors

Please list any civic or military involvement that you feel is relevant:

_____________________________________________________________________

VI. Miscellaneous

Please list any other athletic or non-athletic honors that you feel are relevant:

_____________________________________________________________________