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The Western Mustangs Sports Hall of Fame Nomination Form

Directions:

1. The nomination form is important. The selection committee relies heavily on its content when selecting candidates. Please be thorough.

2. List information only once. Do not duplicate. Read Parts A, B, C and D.

3. A maximum of 2 additional pages of information may be attached to this application if required.

You may wish to answer these questions in a Word document first and copy and paste them into the form to avoid losing data.

Nominator Information:

Name:
Email:
Phone Number:

Nominee Information:

Name:
Sex:
Address:
City:
Province:
Postal Code:
Email:
Phone Number:
Cell Number:
Nomination Category:
Years at Western:
Degree(s) and Year(s) of Graduation:
Faculty or Program:
List sports played or coached by nominee:
List administrative/community involvement of nominee:

Part A: Western Mustangs Sports Accomplishments
List years played, colours awarded, university records, MVP awards, Purple Blanket, FWP Jones Award, Claude Brown Award, Sport Specific Wall of Distinction honours and other pertinent information.

Part B: Provincial or League Sports Accomplishments
List league records, all-star selections, playoff performances, MVP, Championships won and other pertinent information not listed in Part A.

Part C: National or International Sport Accomplishments
List national or international accomplishments, all-star selections, national championship performances, Olympics, Pan Am Games and other accomplishments not listed in Parts A and B.

Part D: Other Accomplishments relevant to the nomination
Academic All Canadian – Graduate degrees – Post graduate athletics - Contributions as Ambassador to Western University - Role model to current student/athletes - Youth and community development, etc.

Additional Information: (file upload)
   

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