Hall of Fame Nomination Form

Nominee must:                        

1.         Have made a positive impact on his/her career, community, or the Perkins Schools, and shown evidence of characteristics above and beyond the norm.

2.         Be willing to accept this award in person at the Awards Dinner.  Representatives would be required in the case of posthumous awards.


Please use the space below to nominate your candidate:                 Alumni, Staff, Service (Circle one)

Name of Nominee____________________________________________________________________

Street  Address______________________________________________________________________

City         ______________________________        State        ______________        Zip         _________________

Phone        _____        __________________E-mail ________________________________________________                        

On a separate sheet of paper, please tell in narrative form why you feel this person qualifies to be inducted into the Perkins Hall of Fame. Be thorough. Do not assume the Selection Committee knows your nominee.  Provide as much detailed information as you can. You may need to contact your nominee directly to request information required to complete this form.   Please make sure your information is complete and legible. An example of a detailed nomination may be viewed on the Perkins school website,  Find the “How to Write a Hall of Fame Nomination” in the Forms and Announcements.  If you need assistance or have questions about writing the nomination, contact

The following information is required:                                 Today's Date        ______________________

Name of Nominator        __________________________________________________________________

Street  Address______________________________________________________________________

City         ______________________________        State        ____________Zip_________________________

Phone        ________________________E-mail __________________________________________

                                Send this completed form along with your written nomination to: