MEDINA CITY SCHOOLS HALL OF FAME NOMINATION FORM

Please print in ink. Name of Nominee_________________________________________________________ Nominee’s Address________________________________________________________ Street City Zip Nominee’s Home Phone______________________

Office Phone_________________

High School Attended___________________________ Year of Graduation__________ (non-graduate only) Occupation and Firm/Organization ___________________________________________ CATEGORY OF NOMINATION (check one) □ Academic/Career Life Accomplishments □ Athletic Accomplishments

□ Cultural/Performing Arts □ Special Honorary Achievement

□ Major Contributions to the Medina City Schools

Professional and Voluntary Society/Organizations (current)________________________________ __________________________________________________________________________________ (past)______________________________________________________________________________ Honors, Awards and Distinctions_______________________________________________________ __________________________________________________________________________________ Involvement with the Medina City Schools______________________________________________ Leadership Qualities________________________________________________________________ Reason for Nomination (attach an additional sheet if necessary): __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Your Name__________________________________ Signature______________________________ Address____________________________________________________________________________ Street City Zip Phone Number_______________________________

Date_________________________________

Please send completed form to: Hall of Fame Committee, Medina City Schools 739 Weymouth Road, Medina, Ohio 44256

MEDINA CITY SCHOOLS HALL OF FAME PURPOSE The purpose of the Medina City Schools Hall of Fame program is to recognize Medina High School graduates who have made important contributions and who have provided extraordinary service to their community and chosen field, and to also recognize non-graduates who have served as positive role models to Medina City School District students and have significantly promoted and supported the district. GENERAL GUIDELINES         

At least 10 years between high school graduation and induction (graduates of Medina High School) At least 5 years between service and induction for employees of the district or school board members (non-graduates of Medina High School) Nominee must be a graduate of Medina High School (except for last two categories) Nominations will be kept for five years May nominate a deceased person An individual may be nominated for more than one category Maximum number of inductees per year is five Maximum number of two inductees in each category per academic year Nominations will be accepted from the Hall of Fame Committee, Medina citizens, faculty, students, and graduates

CATEGORIES FOR NOMINATION ACADEMIC/CAREER LIFE ACCOMPLISHMENTS  Respected leader in his/her profession who has demonstrated unique talents and accomplishments  Received academic recognition for his/her achievements while attending the Medina City Schools and/or college ATHLETIC ACCOMPLISHMENTS  Recognized for outstanding athletic accomplishments while attending the Medina City Schools, such as setting new records at the district level or above, winning or placing in state competitions, or ranking as an All-American  Recognized for athletic accomplishments at the college level, sand lot/semi pro, or professional level CULTURAL/PERFORMING ARTS  Recognized for achievements in the cultural and performing arts and/or for contributions to the promotion of cultural activities on a local, state, or national level MAJOR CONTRIBUTIONS TO THE MEDINA CITY SCHOOLS  Recognized for promoting the Medina City Schools and by example or by contribution, serving as a major influence in the life of Medina students (graduate or non-graduate) SPECIAL HONORARY ACHIEVEMENT  Although not necessarily a graduate of Medina High School, recognized for special contributions to the Medina City Schools Please complete all of the nomination information on the back of this page.