Scholar Athelete Form - TriCities.com

Scholar-Athlete Nomination Form

Student's Name:
Home Address:
Phone Number:
Age:
GPA:
Sex:	M F
Sport:
High School:
Grade if other than 12 (optional):
Current GPA (3.0 min):

Please describe student's athletic accomplishment:
Other extracurricular activities:
Nominated by:
Daytime Contact Number:
Relationship:	Coach Parent Teacher Administrator Other
Student available for on camera award presentation?	Yes No