CENTREVILLE HIGH SCHOOL ATHLETIC HALL OF FAME

NOMINATION FORM

__________________________________ Category: [ ] Athlete [ ] Coach [ ] Administrator

Name of Nominee

__________________________

Year of Graduation, for Athlete; Dates of Service for Coach/Administrator

Membership is open to all athletes beginning five years after they left Centreville High School in good standing (either by graduation or a move out of the area) or in special circumstances as determined by the Board Members; such athletes must have competed in a VHSL-sanctioned varsity sport and must have excelled in such sport. Among accomplishments taken into account will be individual (all-District, all-Region, all-State, all-Met) and team accomplishments, individual school or team records held, and impact on teams and the overall athletic program at Centreville High School during their era.

Membership is also open to coaches or administrators, who must have participated with distinction and/or made significant contributions to athletics at Centreville High School, as evidenced, for example, by the success of their teams and the acknowledgement of their former student-athletes. Such coaches or administrators shall be eligible for membership beginning five years after they have left Centreville High School for any reason, or in special circumstances as determined by the Board Members.

Additional Current Information on Nominee, if Known

Current Address ______________________________________ Phone _____________________

City _________________________ State ____________ Zip ___________

E-mail Address ___________________________________

Nominee’s Sport(s) and Academic Years of Participation _____________________________________________

Or years and teams coached _____________________________________________

Please list below any information you feel is relevant to the nomination. Bullet form summary accompanied by specific, documented sources will help the Election Committee verify any individual or team statistics or achievements and should be included. Feel free to attach additional sheets of documentation if available.

List of Centreville High School accomplishments as well as post high school (if applicable):

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Please give 3 -5 sentences to describe the nominee’s contributions, accomplishments and personal biography that could be quoted in a program.

A picture of the nominee (preferably while at CVHS) if possible should be attached.

Name, address and relationship to nominee of person submitting nomination (please print)

Name _______________________________________

Address ______________________________________________

Relationship to nominee ________________________________________

Who would be the best person to give the introduction at the banquet? _________________If someone other than yourself, please include their email_________________________ and home phone number____________________________________.

If at all possible, please include a personal statement of support from a coach or teammate other than the nominator:

___________________________________________________________________________________________________

Coach’s/Teammate’s name_________________________________________ Sport ___________________________

Address _______________________________________________________________________________

Home Phone___________________________ Email address___________________________________

The office of the Director of Student Activities will send acknowledgement

of the receipt of your nomination materials.

All application materials become the property of the Board of the CVHS Athletic Hall of Fame;

the information will not be returned to the nominator unless specifically requested.

Please return this form to:

Director of Student Activities

Jimmy Sanabria

703-802-5416 office

Centreville High School

6001 Union Mill Road

Clifton, VA 20124

Revised 5.1.2017