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Athletic Hall of Fame Induction Form

Inductee's Information

Please fill out all fields if applicable.

First

(Maiden)

Last

Chadwick School

Address 1

Address 2

City

State

Zip

Date of Birth (mm/dd/yyyy)

Home Phone

Cell Phone

Office Phone

Inductee won Letter(s) in the following sport(s)

If applicable, inductee served as a Chadwick coach in the following sport(s)

If applicable, inductee served as an athletic administrator at Chadwick from:

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Post-Secondary Education:

College Information

High School Athletic Record (Please be as detailed as possible):

Freshman Year

Sophomore Year

Junior Year

Senior Year

High School Extracurricular Activities:

Honors and Awards Recieved

Statistics

Coaching records or administrative achievements, if applicable:

Membership in Clubs, Organizations, Lodges, Societies, Academies, etc. (including positions held):

Hobbies

Present Occupational Position (Title)

Organization

Address 1

City

State

Zip

Marital Status:

If Married, Spouse's name

Maiden Name

Other Information

Attach File

If you would like to additional supporting documents to this nomination form please attach it here.

Max file size: 10 MB

Attach File

Max file size: 10 MB

Please contact Monica Buck (alumni@chadwickschool.org).

IMPORTANT: Inductee must be present for the induction ceremony in fall 2022.

The deadline for this receipt of information is April 3, 2022.

Please send a confirmation email to the address below*: