SCSHA Wall of Gratitude Nomination Form
The following contact information must be provided for the nomination to be considered. If the
nominee is deceased, please provide contact information for nearest family member:
Candidate Name *
Your answer
Phone Number *
Your answer
Candidate Email *
Your answer
Candidate Address *
Your answer
Years of Contribution to the SCSHA *
Your answer
Nominated by *
Your answer
Date Submitted *
MM
/
DD
/
YYYY
Describe contributions to the SCSHA *
Your answer
Were there multiple roles over the years? Were there different time periods for the volunteer efforts? What special acknowledgements would you include? *
Your answer
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