Distinguished Coach Nomination form

Name of person making the nomination:

Position of the person making the nomination:

Nominators School Name:

Nominators School Address:

Nominators School Phone #:

Nominators School FAX #:

Nominators Home Phone #:

Nominators Email address:

Sport of Nomination: Select one of the following Boys Cross Country Girls Cross Country Boys Track & Field Girls Track & Field

Nominees Name:

Nominees Position:

Nominees School Name:

Nominees School Address:

Nominees School Phone #:

Nominees School FAX #:

Nominees Home Phone #:

Nominees Email address:

Additional information needed

How many years did this nominees coach? (5 year minimum):

What Sports did the nominee Coach and/or provide service?

Select one of the following Cross Country Track & Field MTCCCA OTHER

What contributions did the nominee make to the sports of Track & Field and/or Cross Country?

In the text box below, List the name/names of the State Champion athletes that the nominee coached,
Please provide the State Champions name, Event, and year won.

Name: Event: Year: Name: Event: Year:

In the text box below, List the name/names of the Multiple Sectional Champion athletes that the nominee coached,
Please provide the Sectional Champions name, Event, and year won.

Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year:

In the text box below, List the name/names of the Multiple District Champion athletes that the nominee coached,
Please provide the District Champions name, Event, and year won.

Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year:

In the text box below, List the name/names of the Multiple School and/or Conference Record Holders that the nominee coached,
Please provide the Name, Event, and year of record.

Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year: Name: Event: Year:

Service to the sports of Track & Field and/or Cross Country

In the space provided, please list information about service to Track & Field and/or Cross Country Meet Director, and/or Camp Coach, and/or service to the MTCCCA, and/or Coached Weight Lifting, and/or coached Off-Season Work, and/or Volunteer service to Track & Field and/or Cross Country.