Individual Nomination Form

Nomination notes:

The nomination form is important. The selection committee relies heavily on the content of the nomination form when selecting candidates for the Western Mustangs Sports Hall of Fame. Please be as thorough as you can.
The nomination will be added to a file of nominees that is reviewed yearly by the selection committee.
A nominee is not eligible for induction until ten years after graduation. Nominations can be submitted anytime.
The selected candidates will be recognized and honoured at the Western Mustangs Sports Hall of Fame Dinner on the Friday night of Homecoming.
Pictures of all inductees are displayed on the Western Mustangs Sports Hall of Fame wall in Alumni Hall.
You will receive confirmation that your submission has been received via a separate email.

Date:

Name of person making the nomination:

Email:

Phone#:

Name of nominee:

Nominee’s address:

Nominee's Email

Nominee's Phone#

Male Female

Nominator’s Contact Information

City:

Province:

Postal code:

Email:

Phone#:

Cell#:

Classification

Nominee’s category: Athlete Athlete/Builder Builder

Years at Western:

Degrees and year of Graduation:

Faculty or Program:

List sports played or coached by nominee:

Western Mustangs Sports Accomplishments
List years played, colours awarded, university records, MVP awards, Purple Blanket, FWP Jones Award, Claude Brown Award, Sport Specific Wall of Distinction honours and other pertinent information.

Provincial or League Sports Accomplishments
List league records, all-star selections, playoff performances, MVP, Championships won and other pertinent information not listed in Part A. Part

National or International Sport Accomplishments
List national or international accomplishments, all-star selections, national championship performances, Olympics, Pan Am Games and other accomplishments not listed in Parts A and B.

Other Accomplishments relevant to the nomination
Academic All Canadian – Graduate degrees – Post graduate athletics - Contributions as Ambassador to Western University - Role model to current student/athletes - Youth and community development, etc.