Lifetime Achievement 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
The nomination will be added to a file of nominees that is reviewed yearly by the selection committee.
The selected candidate 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

Phone

Name of nominee

Male Female

Nominee's address

Province

Postal code

City

Phone

Cell#

Faculty of program

Institution Attended, Degrees and year of Graduation

List sports played or coached by nominee

Western Mustangs Sports Accomplishments

National/International/Professional Accomplishments

Academic and Career Accomplishments

Community Involvement

Contributions as Ambassador to Western