Date Submitted: _

GOAL: To help students become knowledgeable participating members of society equipped with education and the necessary skills to meet tomorrows challenges.

Southern High School Alumni Association 8620 Preston Highway Louisville, KY 40219
Hall of Fame Nomination Form
ELIGIBILITY FOR INDUCTION: Those selected to join the Southern High School Hall of Fame must have met one or more of the following criteria: Demonstrated outstanding success in academics, athletics, or leadership while enrolled at Southern. Demonstrated a recognizable degree of proficiency in these areas after graduation from Southern. Made an outstanding contribution to the students and staff of Southern as a teacher, coach, administrator, or supportive member of the community. Must be out of high school a minimum of ten (10) years. A past criminal record will disqualify a nominee. INSTRUCTIONS: Any alumni or friend of Southern High School may submit the names of nominees. Nomination deadline is February 28. An official nomination form must be completed for each nominee. Additional information may also be submitted with the form (newspaper clippings, magazine articles and other supportive materials would be helpful to the selection committee). The selection committee will meet in March. Should the nominee not be chosen in the submission year, nomination forms will remain in effect for up to 3 years. All information on this form (and accompanying data) must be submitted to the Southern High School Alumni Office, Southern High School, 8620 Preston Highway, Louisville, KY 40219. Once the nomination form is received, all actions necessary to the selection process will remain confidential. All information submitted will be retained by the Alumni Office.

Name: Address: City: Telephone: ( ) State:

Class of Zip:

1. Honors, awards and special recognition while attending Southern High School:

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2. Additional education: School: Majors: Major(s): School: Degree: Year 3. Honor, awards and special recognition while attending college or other educational institution. Degree: Year

4. Business and professional history (include job title, ownerships, or other pertinent information):

5. Civic and community involvement please list leadership roles, honor, recognitions, awards, etc.

6. In addition to the information given, why do you believe your nominee should be included into the Southern High School Alumni Hall of Fame:

Nominated by Address: City: Phone: Home ( ) State: Work: ( ) Zip:

If you have any questions, please call the Alumni Association at 502-485-6530, leave your name and phone number and an Alumni Association officer will return your call.

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