Hall of Fame Staff Form

WATERLOO WEST HIGH SCHOOL HALL OF FAME

Nomination Form for West High Staff

*Please note: In order to complete this application you must copy and paste the information below on a word document.  Print it out and give it  to one of the following:  Academic Dean or The West High Student Services Office located at: West High School, 425 E. Ridgeway Ave., Waterloo, IA, 50702.

*For more information, please contact Beth Wagner, West High Academic Dean, at 433-2700.

Submitted by:

Telephone:

E-mail:

Date submitted:

Please fill out the following information to the best of your knowledge. Completed forms should be submitted to the Academic Dean, West High Student Services Office, West High School, 425 E. Ridgeway Ave., Waterloo, IA, 50702. For more information, please contact Beth Wagner, West High Academic Dean, at 433-2700.

Nominee:

Business Address:

Home Address:

Telephone:

Years of service at West High:

Responsibilities at West High (Position, years, description):

Professional Awards, Honor, Achievements:

Community Service/Philanthropy:

Military Service (including years of active duty and honors/awards):

Please describe why this West High staff member should be inducted into the West High Academic Hall of Fame. Include all information which you believe will assist the committee in evaluation your nominee.