Haverford College

Required fields are marked in italics.

Nominator Information

Your Name:

Your E-mail:

Your Phone Number:   Home Work

Your Class Year or Other Haverford Affiliation:

Your Street Address:

City:    State:    Zip Code:

Nominee Information

First Name:

Middle/Maiden Name:

Last Name:

Class Year:

E-mail:

Daytime Phone: Home Work Cell

Evening Phone: Home Work Cell  

Street Address:

City:   State:   Zip Code:

Deceased: Yes No

Sport(s) Played at Haverford:

Please explain how the nominee demonstrated significant success/achievement in their sport(s).
Include any records, award, statistics, etc.

Please provide any additional comments below.