HALL OF FAME NOMINATION FORM

Surname with Title
(Mr/Mrs/Miss/Rev/Dr/Prof/etc)

First Name

Other Names

Category in which Nomination made

Member of Administration; or Member of Staff; or Old Boy

Criterion for Nomination (SEE Criteria for Induction)

Home Address

Tel #

Your email

Fax #

Jamaican Honours/Awards conferred

Profession/Occupation Work History

Basis for Recommendation
(Attach separate sheet setting out in detail the basis for Nomination)

NOMINATOR

Name of Nominator:

Address of Nominator:

Tel #

Email Address of Nominator

Category (See Persons entitled to make Nomination)

Relationship with Nominee

Date

I agree to the best of my knowledge that the information in this form is correct

NOTE: Additional data in the form of a current and brief biographical outline which includes the
Nominee’s achievements or details of service rendered as well as other information which may be of assistance in the selection process should be attached.

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