Hall of Fame Nomination Form

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Email address *

Please Check Classification of Participation in Region XVI

Contributor Coach Player

Candidate Name

Candidate Contact Phone

Candidate Current Address

Name of Person Submitting Nomination

College of Nominating Party

Contact Phone of Nominating Party

Contributor Classification

Major Contribution(s) to Region XVI

Coach Classification

Region XVI Colleges Worked

Please include dates of employment

Total years of JUCO Coaching

JUCO Record

Won-Lost-Tied

Special Honors and Awards

Contributions to Region XVI

Student Athlete Classification

NJCAA Region XVI College Played

Please include dates

Special Honors & Accomplishments during JUCO career

Contributions & Accomplishments after JUCO

Please send a photo of your nomination to Jay Mehrhoff, Assistant Men's Regional Director

* required field