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_____________________

 

Team______________________________________  Year_____________________

 

Team______________________________________  Year_____________________

 

 

National honors received:

 

Honor ____________Event_____________Location ____________Year__________

 

Honor ____________Event_____________Location ____________Year__________

 

Honor ____________Event_____________Location ____________Year__________

 

Honor ____________Event_____________Location ____________Year__________

 

 

III.           Coaching Career

 

Head Coaching Positions:

 

Team__________________________  Year(s) ____________  Record _____________

 

Team__________________________  Year(s) ____________  Record _____________

 

Team__________________________  Year(s) ____________  Record _____________

 

Team__________________________  Year(s) ____________  Record _____________

 

 

Assistant Coach:

 

Team__________________________  Year(s) ____________  Record _____________

 

Team__________________________  Year(s) ____________  Record _____________

 

Team__________________________  Year(s) ____________  Record _____________

 

 

 

 

 

 

Coaching Honors:

 

Honor_____________________________________  Year______________

 

Honor_____________________________________  Year______________

 

 

IV.           Officiating/Umpiring Career

 

Years served as an official/umpire:

 

Years_______________  Level ________________  Association____________

 

Years_______________  Level ________________  Association____________

 

Years_______________  Level ________________  Association____________

 

Years served as official/umpire for championship play?

 

Event______________________  Year________________  Location___________

 

Event______________________  Year________________  Location___________

 

Event______________________  Year________________  Location___________

 

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

 

Event____________________________________  Year________________

 

Event____________________________________  Year________________

 

 

Personal honors received as an official/umpire:

 

Honor________________________________  Year_____________________

 

Honor________________________________  Year_____________________

 

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)_______

 

Title______________________  Organization_______________ Year (s)_______

 

Title______________________  Organization_______________ Year (s)_______

 

Title______________________  Organization_______________ Year (s)_______

 

 

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

 

Accomplishment___________________________________  Year____________

 

Accomplishment___________________________________  Year____________

 

Accomplishment___________________________________  Year____________

 

Accomplishment___________________________________  Year____________

 

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

 

Honor_____________________________________  Year________________

 

Honor_____________________________________  Year________________

 

Honor_____________________________________  Year________________

 

Honor_____________________________________  Year________________

 

Administrative/Committee Experiences:

 

Committee_____________________Position Held______________ Year______

 

Committee_____________________Position Held______________ Year______

 

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:

 

_____________________________________________________________________

 

_____________________________________________________________________

 

_____________________________________________________________________

 

_____________________________________________________________________