SCSHA Wall of Gratitude Nomination Form

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SCSHA Wall of Gratitude Nomination Form

The following contact information must be provided for the nomination to be considered. If the
nominee is deceased, please provide contact information for nearest family member:

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* Indicates required question

Candidate Name *

Your answer

Phone Number *

Your answer

Candidate Email *

Your answer

Candidate Address *

Your answer

Years of Contribution to the SCSHA *

Your answer

Nominated by *

Your answer

Date Submitted *

MM

/

DD

/

YYYY

Describe contributions to the SCSHA *

Your answer

Were there multiple roles over the years? Were there different time periods for the volunteer efforts? What special acknowledgements would you include? *

Your answer

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