(954) 462-6536

International Swimming Hall of Fame Nomination Form For Honoree Consideration

International Swimming Hall of Fame

 

Nomination Form For Honoree Consideration

 

1 Hall of Fame Drive * Fort Lauderdale, FL 33316 * (954) 462-6536

 

(Please type or print clearly)

 

LAST NAME: ___________________________________________________________

 

FIRST NAME: ___________________________________________________________

 

NICKNAME: ____________________________________________________________

 

ADDRESS: _____________________________________________________________

 

PHONE: ________________________________________________________________

 

DATE OF BIRTH: ________________________________________________________

 

PLACE OF BIRTH: _______________________________________________________

 

CITIZENSHIP OR COUNTRY REPRESENTED: ______________________________

 

IF DECEASED, DATE OF DEATH: _________________________________________

 

 

PLEASE INDICATE THE CATEGORY OF THE NOMINEE:

 

 

 __________ SWIMMER

 

 __________ DIVER

 

 __________ WATER POLO PLAYER

 

 __________ SYNCHRONIZED SWIMMER

 

 __________ COACH

 

 __________ CONTRIBUTOR (Point of Service)

 

 

 

Complete the following items with as much detail as possible.  Be specific to your sport.

Coaches list your athletes who competed in each of the areas.  Use additional paper if

needed.

 

 

I.  OLYMPIC HISTORY

 

Medals attained:     Gold __________

 

Coaches list total number of medals         Silver __________

attained by their athletes

            Bronze __________

 

     Other final placings __________

 

 

A. CHRONOLOGICALLY LIST THE OLYMPIC GAMES IN WHICH THE

NOMINEE PARTICIPATED:  Include events, relays, strokes, times, records

established, games, goals scored, position, honors received, results, etc.

 

 

 

 

 

B. COACHES AND CONTRIBUTORS LIST INVOLVEMENT WITH EACH OF

THE GAMES:  Include position(s) held, etc.  For example - coaching, managerial,

administrative, etc.

 

 

 

 

 

 

 

II.  WORLD RECORD HISTORY

 

 

 Number of individual World Records attained: _________________

 

 Number of relay World Records attained: _____________________

 

 (Coaches list total number of World Records attained by their athletes)

 

 

A. CHRONOLOGICALLY LIST EACH WORLD RECORD SET:  Include

event, time, date, location, etc.  Coaches lit their athletes and records.

 

 

 

 

 

 

 

 

 

 

III.  WORLD CHAMPIONSHIP HISTORY

 

Number of Medals attained:    Gold __________

 

(Coaches list total number of medals         Silver __________

attained by their athletes)

            Bronze __________

 

     Other final placings __________

 

 

A. CHRONOLOGICALLY LIST THE WORLD CHAMPIONSHIPS IN WHICH

THE NOMINEE PARTICIPATED:  Include, events, relays, results, times, records

established, games, position, goals scored, honors received, etc.  Coaches list their

athletes who competed and results.

 

 

 

 

 

B. COACHES AND CONTRIBUTORS LIST PERSONAL INVOLVEMENT WITH

EACH OF THE CHAMPIONSHIPS:  Include positions held, etc.  For example -

coaching, managerial, administrative, etc.

 

 

 

 

 

 

 

IV.  NATIONAL CHAMPIONSHIP AND NATIONAL RECORD HISTORY

 

 Number of National Championships attained: __________

 

 Number of National Records set:   __________

 

 (Coaches list total number of national championships

  and records attained by their athletes)

 

 

A. CHRONOLOGICALLY LIST EACH NATIONAL CHAMPIONSHIP

ATTAINED:  Include events times, scores, dates, locations, games, position, goals

scored, honors received, etc.

 

 

 

 

 

B. INDICATE FROM "A" ABOVE, WHICH WERE NATIONAL RECORDS:

 

 

 

 

 

C. COACHES LIST THE YEARS AND MEETS IN WHICH TEAMS WON A

NATIONAL TEAM CHAMPIONSHIP: Include title, score, date, location, etc.

 

 

 

 

 

 

V.  HISTORY OF:

 

 (Check 1 per page)

    __________ Commonwealth Games

 

    __________ Pan American Games

 

    __________ European Championships (LEN)

 

    __________ Asian Games

 

    __________ Other ____________________

 

 

Number of medals attained:

(Coaches list number of medals attained by their athletes)

 

    Gold __________

 

           Silver __________

 

           Bronze __________

 

    Other final placings __________

 

 

A. CHRONOLOGICALLY LIST EACH EVENT: Include relays, times, records

establishes, games, position, goals scored, honors received, results, etc.

 

 

 

 

 

B. COACHES AND CONTRIBUTORS LIST PERSONAL INVOLVEMENT WITH

EACH OF THE GAMES: Include positions held.  For example - coaching,

managerial, administrative, etc.

 

 

 

 

 

 

 

VI.  UNIVERSITY, COLLEGE, OR SCHOOL COMPETITION

HISTORY

 

 Number of collegiate National Championships attained: __________

 

 

A. CHRONOLOGICALLY LIST UNIVERSITY OR COLLEGE NATIONAL

CHAMPIONSHIPS ATTAINED:  Include events, relays, times, records

established, games, position, goals scored, results, honors, etc.

 

 

 

 

 

B. LIST NAMES OF COACHES UNDER WHICH THE NOMINEE SWAM,

DIVED, PLAYED OR PERFORMED:  Include dates, team and location.

 

 

 

 

 

C. COACHES LIST THE YEARS AND MEETS IN WHICH TEAMS WON A

NATIONAL TEAM CHAMPIONSHIP:  Include title, score, date, location, etc.

 

 

 

 

 

 

 

VII.  LIST SPECIAL HONORS AND AWARDS RECEIVED:

 

 

 

 

 

 

 

VIII.  LIST INTERNATIONAL AND NATIONAL

ORGANIZATIONS AND ASSOCIATIONS ON WHICH THE NOMINEE

SERVED OR WAS APPOINTED

 

 

 

 

 

 

 

IX.  LIST "MILESTONE" ACHIEVEMENTS OR "FIRSTS" IN

THE SPORT WHICH WERE OBTAINED BY THE NOMINEE:

 

 

 

 

 

 

 

X.  ADDITIONAL INFORMATION OR DIALOGUE WHICH IS

HELPFUL IN PREPARING INFORMATION FOR THIS HONOREE:

 

 

 

 

 

 

 

 

 

 

 

      Submitted by:

 

      _________________________

      Print Name

 

      _________________________

      Signed

 

      _________________________

      Date

 

      _________________________

      Telephone

 

 

 

 

 

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