Application Form

Use this form to nominate candidates.:

1.
*

Nominees Name:
2.
*

Nominees Address:
3.
*

Nominees City, STATE  Zip
4.
*

Nominees Daytime Phone:
5.

Nominees Evening Phone:
6.

Nominees Email Address:
7.

Nominees Fax:
8.
*

Dates Nominee Attended or Worked at Sr. High or MHS:
9.

Nominees Spouses Name:
10.

Nominees Parents Name:
11.

Nominees Childrens Name(s) - Age(s):
12.

Nominees High School Athletic Achievements:
13.

Nominees College Athletic Achievements:
14.

Nominees Additional Athletic Achievements:
15.
*

Submitters:
Name:
Street:
City/State/Zip:
Telephone#:
E'mail Address:

Type in the text that you see above:

  
Eau Claire Area School District Office · 500 Main Street, Eau Claire, WI 54701-3770 · phone: (715) 852 3000 · fax: (715) 852 3004
Copyright © 2009 Eau Claire Area School District. All Rights Reserved.