PCD Athletic Hall of Fame – Nomination Form 2010
DEADLINE FOR SUBMISSIONS: July 12, 2010

Note: Please provide as much information as possible on the candidate(s) you nominate. Please use additional sheets if necessary and/or include copies of news clippings or other material with your submission. Previous year’s nominations remain eligible so it is not necessary to re-nominate candidates. Feel free to duplicate this form. You may also copy and paste this information into an e-mail and send to alumni@providencecountryday.org or print and fax to 401-435-4514.

NOMINEE INFORMATION
Name(s):

Affiliation with Country Day: (graduate, faculty, coach etc.)

Year of graduation:

Achievement(s) of nominee that merit induction in the Athletic Hall of Fame: Please be as
specific as possible and feel free to attach additional documentation.


Other noteworthy achievements: (career, community service, etc.)


NOMINATOR INFORMATION
Your name:

Address:

Home Phone: Business Phone: E-mail address:

RETURN THIS FORM NO LATER THAN JULY 12, 2010 TO:

PCD
Athletic Hall of Fame
Providence Country Day School
660 Waterman Avenue
East Providence, RI 02914