Prairie Central High School Alumni Hall of Fame

NOMINATION FORM  

PLEASE COMPLETE THE FOLLOWING

1.   Your Name  ____________________________________________________
2.    Your Address  ____________________________________________________
       City  __________________     State _____
3.   Your Phone Number  ___________________________________
4.   Individual you are nominating  _______________________________________
5.   What is your relationship to nominee and how long have you known this individual?
        ____________________________       ______________________________
6.   Year of Nominee’s Graduation from Prairie Central H.S.  ______________________
7.   Address of Nominee  _______________________________
       City ___________________     State _____
8.   Phone Number of Nominee  ______________________________
9.   Please provide your reasons for nominating this person
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10.   Please list the names & addresses of three (3) persons who will be providing letters of reference.

a._________________________________________________________________________________
b._________________________________________________________________________________
c._________________________________________________________________________________

DEADLINE:  March 15, 2008

The P.C.H.S. Hall of Fame Committee will uphold complete confidentiality regarding each candidate's nomination status.

MAIL TO:   P.C.H.S Hall of Fame Committee                FAX TO:    (815)  692-2438
                    Prairie Central High School
                    411 N. 7th St.
                    Fairbury, IL 61739