CANDIDATE INFORMATION

Candidate's Name:

Profession/Occupation:

Job Title:

Name of Company/Organization:

E-mail Address:

Business Address:

Home Address:

Phone (Home):
(Work):
(Fax):

New Paltz Degree:

Major:

Graduation Date:

Sport(s) Participated:

Other Education (not at New Paltz):

Additional information supporting this nomination as noted.

NOMINATOR INFORMATION

Name:

E-mail:

Address:

Phone (Home):
(Work):
(Fax):

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