Hall of Distinction

Nomination Form

Student Coach Faculty Staff Career Achievement

Nominee Information

First Name:

Middle Name:

Last Name:

Maiden Name:

Address:

City:

State:

Zip:

Email:

Date of Birth:

Deceased:

Phone:

Work Number:

Cell Number:

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