Wall of Fame Nomination Form

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Thank you for choosing to submit your recommendation for the Viterbo University Athletic Wall of Fame.

Nominee's Name: *

Graduating Class Year: *

Nominated for: *

Student-Athlete Coach/Administrator/Faculty/Staff Benefactor/Meritorious Support Honorary/Special Membership

Category I: Student-Athlete

Sport(s) Participated in:

Years of Participation:

Year of Graduation:

Outstanding Accomplishments/Contributions:

Category II: Coach/Administrator/Faculty/Staff

Position/Title (i.e. coach, athletic director, etc.):

Years of Employment/Service:

Outstanding Accomplishments/Contributions:

Category III: Benefactor/Meritorious Support

Outstanding Accomplishments/Contributions:

Category IV: Honorary/Special Membership

Outstanding Accomplishments/Contributions:

Email address *

First name *

Last name *

Address 1 *

Cell Phone Number *

* required field