Blue KC Sporting Samaritans Nomination Form
* Required
Nominator Info
First Name (Nominator)
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Your answer
Last Name (Nominator)
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Your answer
Email Address (Nominator)
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Your answer
Phone Number (Nominator)
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Your answer
Nominee Info
First Name
*
Your answer
Last Name
*
Your answer
Email Address
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Your answer
Phone Number
*
Your answer
Is your nominee a student, teacher, or teacher/coach?
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Student
Teacher
Teacher/Coach
Other:
If they are a student, teacher, or teacher/coach, what is your school name and grade?
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Your answer
Explain in 250 words or less why your nominee should be selected as a "Blue KC Sporting Samaritan"
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Your answer
To the best of your knowledge, is this person recognized as an outstanding student/educator and person of good character by other students/colleagues?
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Yes
No
The nominee is willing to be included in a press release if selected
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Yes
The nominee lives within 75 miles of Children’s Mercy Park
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Yes
I agree to the official rules (SportingKC.com/BlueKC/rules)
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Yes
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