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USILA Scholar All-America Nomination Form
To nominate a senior student-athlete for USILA Scholar All-America, please complete the following nomination form.

All nominations must be completed and received by the committee no later than Friday, May 11, 2012.

For questions, please contact Bill Tierney at 303-871-3531 or william.tierney@du.edu.

Required Fields in Bold
 
NOMINEE'S PERSONAL INFORMATION
Nominee's Name:
 
Institution:
 
Date of Birth (MMDDYYYY) (please do not enter in dashes or slashes):
 
Home Street Address:
 
City:
 
State:
 
Zip Code:
 
Nominee's Cell Phone:
 
Nominee's E-mail Address:
 
Nominee's Dad's Name:
 
Nominee's Mom's Name:
 
Sports Information Director's Name:
 
Sports Information Director's Phone Number:
 
Sports Information Director's E-mail:
 
Lacrosse Coach's Name:
 
Lacrosse Coach's Cell Number:
 
Lacrosse Coach's Office Number:
 
Lacrosse Coach's E-mail Address:
 
 
ACADEMIC CRITERIA
Major:
 
Degree Program (please select):
 
B.A.
B.S.
M.S.
M.A.
Other
Grade-Point Average:
 
Graduation Date (MMDDYYYY)
 
 
Verification of graduation and cumulative grade point average: By my signature I certify the graduation date and GPA of this nominee.
 
Name of Academic Officer:
 
Title of Academic Officer
 
Academic Officer's Office Number:
 
Academic honors, campus honors or comments:
 
 
LACROSSE CRITERIA
Position (select one):
 
Attackman
Midfielder
Face-off specialist
Long-Stick Midfielder
Short-Stick Midfielder
Defender
Goalkeeper
NCAA Division (select one):
 
I
II
III
Team Captain?:
 
Yes
No
Has the nominee been nominated for Lacrosse All-America Honors in 2011?
 
Yes
No
Has the nominee been nominated for the North-South All-Star Game in 2011?
 
Yes
No
 
ATHLETIC HONORS
Please list the institutional, national, conference, regional, state and other athletic honors the nominee has received over his collegiate career (include honors received as an underclassman).
 
 
ELECTRONIC SIGNATURES

(these will serve as the signatures required to complete the nomination process)

Name of Head Coach Completing Nomination Form:
 
Date (MMDDYYYY) (please do not enter in dashes or slashes):
 
Name of Athletic Director:
 
Date (MMDDYYYY) (please do not enter in dashes or slashes):
 
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