Nomination Form Submission

School Attended
Massapequa High School‎Berner High School‎







1. Please provide a brief summary of the candidate’s career. Include any extraordinary successes achieved.

2. Please provide information pertaining to exemplary service to the community or family service involving youth, church, school, and or civic groups.

3. Please provide a brief statement supporting the induction of the nominee as a candidate that can readily be recognized as an outstanding role model for the community and our students.

Note to Sponsors: Thank you for your nomination. Prior to submission, please contact the nominee to assure that he/she is interested in being considered for induction. Attendance is encouraged, but not required for induction. Sponsors are advised that the Nominations Sub-Committee has a backlog of nominations and utilizes a multi-year consideration process.