Please complete the following form to the best of your ability to nominate a deserving individual for the Lees-McRae College Fred I. Dickerson Athletic Hall of Fame. For a complete list of the nomination criteria, please click here.


I. Nominee's Personal Information

Full Name:
Street Address:
City:
State:
Zip:
Phone Number:
Date of Birth:
Place of Birth:
Hometown Newspaper:
Street Address of Newspaper:
City:
State:
Zip:


II. Educational Background

High School Attended:
City:
State:
Year of Graduation:
First College Attended:
Degree Earned:
Field of Study:
Year of Graduation/Last year attended:
Second College Attended:
Degree Earned:
Field of Study:
Year of Graduation/Last year attended:
Third College Attended:
Degree Earned:
Field of Study:
Year of Graduation/Last year attended:


III. Family Background

Name of Spouse:
Son(s)'s name(s) and age(s):
Daughter(s)'s name(s) and age(s):
Father's name:
Mother's name:


IV. Intercollegiate Athletics

Participation:

Sport Yrs. Competed Varisty Letters Capt/Co-Capt
Baseball
Basketball
Cross Country
Cycling
Football
Golf
Lacrosse
Skiing
Soccer
Softball
Tennis
Track & Field
Volleyball
Other: 


Honors, awards, and any other distinctions earned in intercollegiate athletics:




Extra Curricular Activities (Student Government Association, Order of the Tower, Greek Life, etc.) Specify orgranization(s) and year(s):




V. Coaching responsibilities (please include records and years) at Lees-McRae or other institutions:



Coaching Awards or honors earned:




VI. Administrative responsibilities (please include years) at Lees-McRae or other institutions:



Professional awards or honors earned:




VII. Military service history

Total years, active or reserve duty:
Highest military rank acheived:
Military assignments or positions held (specify):
List honors, awards, commendations, and medals earned:
Organizational memberships in military service:


VIII. Employment history

Current position held:
Previous positions held (specify years):
Honors, distinctions, awards earned:


IX. Professional activities

Organizational membership:
Community service:
Authorized publications, papers, theses, dissertations, books, magazines, articles, etc.:
Professional honors, awards, distinctions received:

X. Nominator's personal information

Full Name:
E-mail address:
Street Address:
City:
State:
Zip:
Phone Number: