Hall of Fame-Nomination Form

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MAIL NOMINATION TO: C. E. BYRD HALL OF FAME, 3201 LINE AVE. SHREVEPORT, LA 71104

C. E. BYRD HIGH SCHOOL HALL OF FAME OFFICIAL NOMINATION FORM

Date: _________

Membership in the Byrd High School Hall of Fame shall be open to graduates as well as former members of the faculty and administration. In the case of former students, a period of at least ten years shall have lapsed since their graduation. Former faculty and administration members shall not have been actively associated with the school for at least five years. Posthumous nominations will be accepted.

NAME OF NOMINEE: ___________________________________________________________________ (First) (Middle or Maiden) (Last Name)

CURRENT ADDRESS:_____________________________________________________________

PHONE:______________________________________________

YEARS ATTENDED OR ASSOCIATED WITH C. E. BYRD: _______________________

CAPACITY: Faculty____________ Student_____________ Class of _____________

1. ACHIEVEMENTS/SERVICE WHILE AT BYRD:

______________________________________________________________________________

2. NOMINEE’S PERSONAL HISTORY (Please include family):

______________________________________________________________________________

3. PROFESSIONAL/BUSINESS ACHIEVEMENTS:

______________________________________________________________________________

4. COMMUNITY/PUBLIC SERVICE INVOLVEMENT:

______________________________________________________________________________

5. AWARDS/RECOGNITION RECEIVED:

______________________________________________________________________________

6. WHY SHOULD THIS PERSON BE SELECTED FOR THE C. E. BYRD HALL OF FAME?

______________________________________________________________________________

7. NAMES OF OTHER PERSONS WHO CAN PROVIDE ADDITIONAL INFORMATION IF NEEDED. THIS INFORMATION IS FOR THE USE OF THE SELECTION COMMITTEE AND WILL BE CONFIDENTIAL:

Name: ____________________________________________________________________

Phone: Home: ___________________ Office: ______________________

Name: ____________________________________________________________________

Phone: Home: ___________________ Office: ______________________

If you would like to include additional information about nominee, please attach to Nomination Form. All nominations will remain strictly confidential by and property of BYRD HALL OF FAME NOMINATION COMMITTEE.

Submitted by:

Name: ______________________________________________________________________

Address: ____________________________________________________________________

Phone: ______________________________________________________________________

Home Designer: Charles Greene Edited 07/19/2009