2018 Wildcat Wall of Fame Nomination Form
Please provide the following information. You may leave blanks if some information is not known. Applications are due by January 15, 2018. There is a limit of five nominations per individual per year. If a nominee is not selected, they will remain in the pool for future consideration.

A committee of community members, staff members, and students will collect nomination forms and advance finalists based on (1) service or contributions to the school/community, (2) achievements, awards, or honors received, and (3) number of Wildcat Wall of Fame nominations received.

Email address *
Name of person making the nomination (Last, First): *
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Your address: *
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Your phone number: *
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Name of nominee (with maiden name, if applicable) [Last, First]: *
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Nominee's date of birth:
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Nominee's Belleville High School graduation year (if applicable):
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Nominee's year of retirement from the school district (if applicable):
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Nominee's year of death (if applicable):
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Nominee's present address:
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Nominee's home phone number:
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Nominee's cell phone number:
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If you do not know this information, please provide the nominee’s family contact or someone with knowledge about the nominee and a corresponding email or phone number.
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Please check ALL of the criteria that the nominee meets: *
Required
Why is the nominee deserving of induction in the Wildcat Wall of Fame? The explanation may include but is not limited to: Contributions to the school district, community, or greater society; service toward the academic, athletic, or personal success of others; career-related accomplishments and distinctions; degrees earned; academic awards conferred; his or her published works; etc. *
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A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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