Prairie Central High School Alumni Hall of
Fame
NOMINATION FORM
_______
/ ______ / 20 ______
(Date of
Nomination)
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
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
10. Please list the names
& addresses of three (3) persons who will be providing letters of
reference.
a._________________________________________________________________________________
b._________________________________________________________________________________
c._________________________________________________________________________________
DEADLINE:
August 15, 2010
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