Blue KC Sporting Samaritans Nomination Form

Nominator Info

First Name (Nominator) *

Your answer

Last Name (Nominator) *

Your answer

Email Address (Nominator) *

Your answer

Phone Number (Nominator) *

Your answer

Nominee Info

First Name *

Your answer

Last Name *

Your answer

Email Address *

Your answer

Phone Number *

Your answer

Is your nominee a student, teacher, or teacher/coach? *

Student

Teacher

Teacher/Coach

Other:

If they are a student, teacher, or teacher/coach, what is your school name and grade? *

Your answer

Explain in 250 words or less why your nominee should be selected as a "Blue KC Sporting Samaritan" *

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? *

Yes

The nominee is willing to be included in a press release if selected *

Yes

The nominee lives within 75 miles of Children’s Mercy Park *

Yes

I agree to the official rules (SportingKC.com/BlueKC/rules) *

Yes

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