Liberty University Athletics Department

Hall of Fame Nomination Form

Nominee’s General InformationName of Nominee: ________________________________________________________________________________________Circle One: Student-Athlete | Coach | Athletics Administrator | Athletics Contributor

Nominee’s Current Contact Information:Current Address: _______________________________________________________________________________________

_______________________________________________________________________________________Phone Number: (____) ____________________ Email: ____________________________________________________________

Nominee’s Athletic Information:Year(s) of Competition at Liberty: ____________________________________________________________ (example: 1993-96)Sport(s) Nominee Played: ____________________________________________________________________________Major(s) at Liberty: ____________________________________________________________________________

Please list any collegiate accomplishments to support this nomination:(Example: Academic honors, athletics honors, program and conference records, team accomplishments during his/her span with the program, etc.)

Please list any post-collegiate competition opportunities or achievements to support this nomination:(Example: professional/Olympic competition, significant contributions to his/her sport, excellence in his/her professional vocational career, etc.)

Other pertinent information to support this nomination:(Note: Please use this area to provide supporting information for Administrator/Athletics Contributor nominations, plus any other relevant information for this student-athlete or coach nominations)

Nominator’s Contact Information:Name of Nominator: ________________________________________________________________________________________Affiliation with Liberty (Alumnus, employee, Flames Club member, friend, etc.) _______________ (If alumnus, please provide year)Address: __________________________________________________________________________________________________Phone: ( ___ ) _________________________________ Email: ______________________________________________________

Please return this form to Kevin Keys, chair of Liberty’s Athletics Hall of Fame committee:Address: Kevin Keys, Associate Athletics Director, Liberty University, 1971 University Blvd., Lynchburg, VA 24502Email: kkeys@liberty.edu – Fax: (434) 582-2076

Nomination Notes:- To be eligible for the Liberty Athletics Hall of Fames, a student-athlete must be five years removed from competition.- Nominations will be accepted throughout the year and will be evaluated prior to the selection of each year’s Hall of Fame class.- You may include up to one additional page of supporting information, if necessary.