Candidate's Full Name:                                                                                                                                        

Current Address:                                                                                                                                                 

City/State/Zip:                                                                                                                                                     

Work Phone (          )                                                      Home Phone (          )                                                     

Personal History (high school, college, family, etc.) :                                                                                               

                                                                                                                                                                          

                                                                                                                                                                          

NJCAA School Affiliated with with Dates:                                                                                                               

                                                                                                                                                                          

Total Years of Service:              Total Years Football Service:              

NJCAA Coaching Record:                      Other Coaching Record:                      

Special Honors/Awards Received and Year (s):                                                                                                       

                                                                                                                                                                          

Services Performed for NJCAA and Year:                                                                                                              

                                                                                                                                                                          

Services Performed for Football Other Than NJCAA:                                                                                                

                                                                                                                                                                           

Name of Person Making Nomination:                                                                                                                      

Address:                                                                                                                                                              

City/State/Zip:                                                                                                                                                      

Phone: (        )                                                

(Continue on Separate Form If Necessary)

YOUR NOMINATION MUST BE SUBMITTED BY JUNE 15TH AND SENT TO:
Marty Allen, Head Football Coach
Highland Community College - 606 West Main - Highland, KS 66035