NOMINATION FORM

Email address *

First name *

Last name *

Address 1 *

City *

State *

ZIP Code *

Cell Phone Number *

NOMINEE INFORMATION

Name *

Address *

Home/Cell Phone *

Nominee's Employer

Business Phone

Sport(s) *

If "Other", please indicate involvement with Tech Athletics.

ie: Head Coach (Football), Assistant Coach (Softball), Fan, Supporter, Administration, etc.

Years Participated/Involved *

Please fill out each section with as much detail as possible.

Athletic Letters

ie: 1953, 1986-87, etc.

All-Conference Selections

ie: All-OVC First Team (1964), OVC All-Newcomer Team (1977-78), All-OVC (2010)

All-American Selections

ie: All-American First Team (1986), All-American Honorable Mention (1999-00), etc.

Individual Team Awards

ie: Robert Hill Johnson Award winner (1972), Team MVP (1981-82), etc.

Championships Won (Team or Individual)

ie: 1964 OVC Tournament Champions, 1990 OVC Regular Season Champions, 2011 OVC High Jump Medalist, etc.

Records Broken

ie: Program's all-time leading scorer, OVC record holder in free throw percentage, single-season home run record, etc.

Non-Athletic Awards

ie: Derrberry Award winner (1989), ROTC Scholarship (1976-77), Academic All-American (2001), etc.

Additional Supporting Information

Anything else you feel will add to the nominee's resume

Professional Occupation Advancement and Awards

ie: Master's in Education (Vanderbilt, 1989), Commissioned Officer U.S. Army, etc.

Service and Support to Community

Service and Contributions to Tennessee Tech

* required field