National Wrestling Hall Of Fame

Official Nomination to the STATE CHAPTER

Nominated By

Name

Cell Phone

This is an official nomination for the state of

Lifetime Service to Wrestling

Medal of Courage

Outstanding American

CANDIDATE INFORMATION

Candidate Name

Candidate Mailing Address

Candidate City

Candidate State

Candidate Zip

Candidate Email

DOB

Place

If deceased, Date of Death

Home phone

Daytime phone

Spouse's Name

Work Phone

Children’s Names/ Ages

Current Profession

Position

Company/School

Retired from Coaching (Year)

SUMMARY OF ACHIEVEMENTS

High School Attended

State

Year of Graduation

HS Years completed

HS W-L Record

College Attended

State

Year of Graduation

College Years competed

Total W-L Record

List Special Honors Earned

WRESTLING CAREER/INVOLVEMENT HISTORY

1. LIFETIME SERVICE TO WRESTLING NOMINEES:

Part I List in chronological order (year to year), minimum of 20 years of coaching, officiating, contributions to wrestling, or any combinations of these.

Part II COACHES: list coaching accomplishments including successful wrestlers, titles, W-L records, etc. OFFICIALS: list officiating accomplishments. CONTRIBUTORS: list accomplishments through the sport. Be sure to include dates for all, in chronological order.

2. OUTSTANDING AMERICAN OR MEDAL OF COURAGE NOMINEES:

Part I In chronological order, list dates of nominee’s professional accomplishments.

Part II In chronological order, list awards, honors and recognition previously received for the nominee’s involvement in wrestling.

3. All NOMINEES:

Part I all wrestling association/public service organizations the nominee currently supports:

Part II Outstanding American & Medal of Courage nominations list awards, honors, and recognition previously received for you involvement in wrestling (include dates)

4. ADDITIONAL INFORMATION:

Use this space to expand on any topics listed above or attach another sheet.

Has nominee ever been convicted of a Felony?

Yes

Our Mission: To honor the sport of wrestling by preserving its history, recognizing extraordinary individual achievements, and inspiring future generations