HOF Nomination Form 03

							                      Centurion Hall of Fame
                                2012
                        Nomination Form

Name: ___________________________ Class Of: ______
Check The Categories That Apply:
_____ Academics
_____ Business
_____ Education
_____ Fine Arts
_____ Military
_____ Philanthropy
_____ Science
_____ Sports
Accomplishments after Graduation (May also attach extra page(s) or
supporting documents):




Contact Information (person submitting nomination form): Name:
_____________________________________________
Phone: ___________ e-mail: ___________________________
     Please return to Ernie Smith @ UCHS, 6949 Genesee Avenue,
                          San Diego, CA 92122
                      Ernestsmith90@gmail.com