RHS Hall of Fame Nomination Form
The primary purpose of the Roosevelt High School Hall of Fame is to recognize individuals who have made a significant
contribution to RHS, and continued in life to make contributions to the local, state and international community. The
recognition of these individuals is intended to highlight and encourage a tradition of excellence, commitment, and
personal dedication at RHS.
Candidate for Hall of Fame:
First Name: ____________________ Middle Initial: _____Last Name: _____________________________
______Living _____ Deceased
Choose One:
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_____ RHS Graduate: _____Yes _____ No
o Maiden Name: _________________________ Year of RHS Graduation: ________________
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_____ Retired RHS faculty/staff member:
o Year of retirement: _________________ Position at RHS: ____________________________
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_____ RHS Contributor
Address: _________________________________________________________________________________
City/State/ZIP: ___________________________________________________________________________
Phone: (_____) ________________________________ Cell: (_____) ________________________________
Email: ___________________________________________________________________________________
Contact Person (if nominee is deceased)
Name: ___________________________________ Relationship to Nominee: _________________________
Address: _________________________________________________________________________________
City/State/ZIP: ___________________________________________________________________________
Phone: (_____) ________________________________ Cell: (_____) ________________________________
Email: ___________________________________________________________________________________
Candidate Nominated by:
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First Name: ____________________________ Last Name: ____________________________
Address: _____________________________________________________________________
City/State/ZIP: _______________________________________________________________
Phone: (_____) __________________________ Cell: (_____) __________________________
Email: _______________________________________________________________________
Area(s) of the Candidate’s Contribution:
_____ Music and the Arts
_____ Politics, Govt. Service, Military
_____ Communications, Publishing
_____ Business
_____ Law, Justice
_____ Science, technology and engineering
_____ Health and Medicine
_____ Education and academics
_____ Politics, Govt. Service, Military
_____ Religion
_____ Athletics
_____ Other: ______________________
Candidate’s Resume:
Briefly provide summary details of the candidate’s credentials and accomplishments based on their
areas of contribution from the previous page that qualify them for such distinction. Please attach a
detailed resume along with any articles, archives, reference letters or other relevant information
about the nominee.
In a few sentences, why do you think this person should be inducted into to RHS Hall of Fame:
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Education, brief career history, civic/community activities:
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Accomplishments, awards and recognitions in area of candidate’s contribution:
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Signature of Nominator: ________________________________________ Date: ____________________
Please send completed form online, by email or by US Mail, by December 1, 2015, to: Roger E.
Wenschlag, Chairman, RHS Hall of Fame Selection Committee, 4829 30th Avenue South,
Minneapolis, MN 55417. email to: RWenschlag@comcast.net
All nominations become the property of the Roosevelt High School Foundation and will not be returned to the nominator, given or
reprinted for the nominee or otherwise distributed.
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