2019 PSADA Hall of Fame Nomination Form
Jon Vallina, CAA
PO Box 152
Langeloth, PA 15054
Email: jon@vallina.org
Email address *
PSADA HALL OF FAME NOMINATION FORM
Full Name (Including Prefix, Middle and Suffix) *
Your answer
Current Address *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
School Affiliation (If applicable), Including School Name, City and State
Your answer
If the nominee is active in the area of interscholastic athletic administration, please explain:
Your answer
Nominee is:
If deceased, closest living relative or contact person (Including address)
Your answer
Nominees Education:
Name of High School Attended (Including Address, Grad Year and Degree Earned)
Your answer
Name of College/University Attended (Including Address, Grad Year and Degree Earned)
Your answer
Name of Post Graduate School (Including Address, Grad Year and Degree Earned)
Your answer
Years in Athletic Administration *
Your answer
Last Year in Athletic Administration *
Your answer
Years as NIAAA Member *
Your answer
Years as State Association Member *
Your answer
NIAAA Certification
Athletic Administrator Category:
Describe career accomplishments and contributions as an interscholastic athletic administrator at the local/district level (i.e. Board of Directors, Committee Members, League President, etc.) *
Your answer
Describe career accomplishments and contributions as an interscholastic athletic administrator at the state/national level (i.e. Board of Directors, Committee Members, Conference Presenter, etc.) including recognitions and awards *
Your answer
A copy of your responses will be emailed to the address you provided.
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