NEWS 12 NEW JERSEY & NJEA SCHOLAR-ATHLETE ACHIEVEMENT RECOGNITION PROGRAM

APPLICATION DEADLINE: FEBRUARY 28, 2014

NOMINATION FORM

(Please clearly print or type ALL responses. ALL information must be completed for consideration.)
Nominee's Name Home Address School School Address

Home Phone ( Parent's Names Sport Date Submitted

School Phone ( Class in School Coach's Name Athletic Dir.'s Name

Senior

Athletic Achievement: (To be completed by Athletic Director or Coach)

Most Current Achievement (Please be specific - Date, Score, Accomplishment) Other Sports Accomplishments

Examples of Leadership (Captaincies, Honors, Positions of leadership)

Statement from Coach Regarding Scholar-Athlete

Academic Achievement: (To be completed by Principal or Guidance Counselor)

Grade Pt. Avg._________ SAT Scores: R_______W_______M_______ Class Rank_______ # in Class_______ School & Non-School Activities (Extra-curricular organizations, Positions held, Clubs & Personal involvement in aiding others)

Comments

(Please use reverse side if additional space is required)

Signature (Principal or Guidance Counselor)

Please submit nomination form with supporting documents using the following methods. Mail: News 12 New Jersey, Scholar Athlete Attn: Deshanna Meyers, 450 Raritan Center Parkway, Edison, NJ 08837; Fax:732-346-1244 or email:scholarathlete@news12.com. An application can also be found on www.njea.org. Selections for televised recognition will be made by the News 12 New Jersey Sports Staff. Nominations with new achievements may be submitted on a weekly basis. Deadline to return applications is February 28, 2014.