Northville Central School Wall of Fame Nomination Form The Northville Central School Wall of Fame is designed to honor the many NCS graduates and staff members who have made significant contributions to humanity, improved the quality of life, or achieved noteworthy recognition in their career or education. The deadline for 2016-2017 nominations is February 17, 2017.

The district’s selection committee invites nominations for future honorees from all members of the Northville community. Nominees should meet the following criteria: ❏ Nominees need not currently reside in the district, but they must be . . . ❏ graduates of Northville (or its predecessors) from the class of 2011 or earlier. or ❏ school personnel who served the district for at least five years. ❏ Nominees may be deceased. ❏ Individuals may not nominate themselves. ❏ A limited number of nominees will be honored each year. If a nominee is not chosen in a given year, he or she will be re-considered in subsequent years. The selection committee and the Northville administration reserve the right to decide which nominees will be honored. Before discussing the nominee, please give us information about yourself: Your name: Your address: Your phone number: Your e-mail address: Date:

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Name of nominee:

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Address, phone number,

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& e-mail address of nominee: ________________________________________________ ________________________________________________ Year of graduation (if NCS graduate):

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Dates of employment in district (if staff member):

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Deadline for 2016-2017 nominations: February 17, 2017 Please discuss in detail why this individual should be honored on the NCS Wall of Fame (attach more sheets if needed). ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Please return form to: Kyle H. McFarland, Chair of Wall of Fame Committee, Northville Central School, 131 South Third Street, Northville, NY 12134