Current Address:

Phone Number: Email: Date Submitted:
* If deceased, please give name, address and phone number of family member.

H.S. and Year of Graduation:

College and Year of Graduation:

Below, list all of the significant accomplishments of the nominee, both as a Rockland County resident and otherwise. Please be as specific as possible. Include varsity sports played in high school and college, dates, letters earned, honors won, records set, post-collegiate achievements, etc.

* Please email us a clear black-and-white or color photo of the nominee or mail in one to the address below. NOTE: You are not done yet! After you email us the photo you MUST continue and fill out the remainder of this form and hit the submit button to complete.

Nominating Person:

First Name: Last:

Address:

Phone Number: Email:

If you are mailing in a photo please submit to:

Bob Veltidi
Chairman, Selection Committee
Rockland County Sports Hall of Fame
400 Jersey Avenue
Greenwood Lake, NY 10925

*If you are mailing in a photo, but have nominated using online nomination please include a note stating that.