Nomination Form

Your Information

Your Name *

Your Email Address *

Your Phone Number *

Nominee's Information

Nominee's Name *

Current Address *

Home Phone *

Business Phone

Current Position/Employer *

High School Career

Graduate of

Year

Address

Sports Participated In

Team Achievement/Honors

Individual Achievement/Honors

College Career

Graduate of

Year

Address

Degree Recieved

Other College attended

Sports Participated In

Team Achievement/Honors

Individual Achievement/Honors

Coaching Career

Number of years coaching: College

Number of years coaching: High School

Win/Loss records: High School

Win/Loss records: College

Achievements as a High School Coach: Include league titles, State Titles, number of girls selected as “All-State”, number of girls to go on to play collegiate basketball, etc. Anything of importance:

Achievements as a College Coach: Include any pertinent information – see the suggestions listed under High School Coach

Career as a Referee

Year Began Career

Year Career Continued Until

Board of Officials worked for

Championships games you have offiicated

Honors that you have recieved

Highest rating that you have attained

Work Experience: High School

Work Experience: College

Honorary Nominee

List and briefly describe any work that you have done on various committees, etc. which have contributed to the enhancement of girl’s basketball in the State of Connecticut. This can include teaching, coaching, refereeing, supporting, publicizing, etc.

CAPTCHA

What code is in the image? *

Enter the characters shown in the image.