Byron-Bergen Central School District Alumni Hall of Fame Nomination Form

Nominee Information: Please provide the below information about the person you wish to recommend for the Byron-Bergen Alumni Hall of Fame.

Name: _______________________________________	Year of Graduation: __________

Address:        ________________________________________________________________ Street                                                        City                                           State                        Zip Code

Home Phone #: (_____) _______________	Work or Cell Phone #: (_____) _______________

Is Nominee: living?	deceased?

Briefly describe those achievements, accomplishments or contributions that cause you to nominate the individual named above for Byron-Bergen Alumni Hall of Fame recognition. Please add additional pages, newspaper clippings, current resume, or other supporting evidence to assist the Selection Committee in their inductee selection process. Please include accomplishments in the following areas:

•	School Contributions/Activities while at Byron-Bergen	•	Job Related Achievements Jr./Sr. High School	•	Professional Honors and Awards
•	Subsequent Contributions to Byron-Bergen Jr./Sr.	•	Professional Affiliations
High School	•	Community/Civic Involvement •	Educational Achievements	•	Other

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If possible, please list other people to serve as resources for Byron-Bergen staff to research additional Nominee information:

Name: ________________________________

Name: ________________________________

Daytime Phone #: (____) ___________

Daytime Phone #: (____) ___________

Person Submitting Nomination:

Name: ________________________________	Daytime Phone #: (____) ___________

Address:        ________________________________________________________________ Street                                                        City                                           State                        Zip Code

Please return this completed form by the annual nomination deadline (first Monday in April) to:

Byron-Bergen Central School District District Office - Attn.: R. Stevens 6917 West Bergen Road Bergen, NY 14416