"HALL OF DISTINCTION" 
Nomination Form

Please print, fill out and return this nomination form and supporting documents no later than JANUARY 15 to:
PO Box 791, Jacksonville, NC 28541

If you have questions, contact Lisa Beavers '88, 910-451-2451 ext 224 or email:  webmaster@lejeunealumni.com.

 

Camp Lejeune High School - Lejeune High School
" HALL OF DISTINCTION"

NOMINATION FORM

NOMINATED FOR CONTRIBUTION AS:                                STUDENT  ______
                                                                                                          COACH      ______
                                                                                                          FACULTY  ______
                                                                                                          STAFF        ______
                                                                             CAREER ACHIEVEMENT  ______

NOMINEE INFORMATION:

NAME   ________________________________________________________________
                  Last                                        First                                 Middle/Maiden

ADDRESS  ______________________________________________________________
                        Street                                      City                                  State            Zip Code

EMAIL ADDRESS _______________________________________________________

DATE OF BIRTH  _____________    DECEASED  ____   

PHONE (home) _______________ (work) _______________ (cell) _______________

NOMINATION STATEMENT: Describe in narrative form contributions this nominee has made to
CLHS/LHS or through career achievements leading to this nomination.   Please attach
supporting documentation. (Example: awards, newspaper articles, letters, etc.)  Give as
much documentation as possible.

Years attended CLHS/LHS: ______   LHS Graduate: Yes __  No __   Graduation Year ____

Please Include:

• High School Athletic/Academic Achievements/Extra-Curricular Activities
• College/University Athletic/Academic Achievements/Extra-Curricular Activities
• Career Achievements/Activities
• Community Achievements/Activities
  

SPONSOR INFORMATION:

NAME  _________________________________________________________________
                      Last                                                   First

ADDRESS  ______________________________________________________________
                      Street                                      City                                   State              Zip Code

EMAIL ADDRESS   ____________________________________________________________

PHONE  (home) __________________ (work) __________________ (cell) __________________

SIGNATURE  ____________________________________________________________