INDIANA BASKETBALL HALL OF FAME
BOYS’ SILVER ANNIVERSARY TEAM NOMINATION FORM
HIGH SCHOOL GRADUATION YEAR ____________
PLEASE TYPE OR PRINT
1. Candidate’s Name _______________________________________________________________________________________________
(Last Name)
(First)
(Middle)
(Nickname)
2. Cell Phone ________________________ Work Phone ___________________________ Home Phone __________________________
E-Mail ___________________________________________
3. Address _______________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
4. Birth _________________________________________________________________________
(Date)
(Place)
5. High School ____________________________________________________________________________________________________
(Year of Graduation)
(Name)
(City & State)
6. High School Athletic Record (Please list team regular season and post-season record, by year; list individual scoring,
rebounding, assist averages when available; summarize records and awards.)
Individual High School stats
Year
Games
FG-FGA (%) 3FG-3FGA (%)
FT-FTA (%)
Rebounds
Assists
Steals
Blocks
Points
PPG
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Career Games FG-FGA (%) 3FGA-3FGM (%)
FT-FTA (%)
Rebounds
Assists
Steals
Blocks
Points
PPG
_________________________________________________________________________________________________________________
Team records and post-season success
Year
Overall Record
Championships won (holiday, county, conference, state tournament, etc.)_
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Please list other school records, individual awards, honors, accomplishments, etc.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
7. High School Coach: Name ________________________________________________________________________________________
Address__________________________________________________________________________________________________________
8. Colleges Attended: _____________________________________________________________________________________________
(Year)
(Degree)
(Field)
(College)
_____________________________________________________________________________________________
(Year)
(Degree)
(Field)
(College)
_____________________________________________________________________________________________
(Year)
(Degree)
(Field)
(College)
9. College Athletic Record (Please list team regular season and post-season record, by year; list individual scoring, rebounding,
assist averages when available; summarize records and awards.)
Individual College stats
Year
Games
FG-FGA (%) 3FG-3FGA (%)
FT-FTA (%)
Rebounds
Assists
Steals
Blocks
Points
PPG
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Career Games
FG-FGA (%) 3FG-3FGA (%)
FT-FTA (%)
Rebounds
Assists
Steals
Blocks
Points
PPG
_________________________________________________________________________________________________________________
Team records and post-season success
Year
Overall Record
Championships won (holiday, county, conference, state tournament, etc.)_
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Please list other school records, individual awards, honors, accomplishments, etc.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
11. College Basketball Coach: Name _________________________________________________________________________________
Address_______________________________________________________________________________________________________
12. Basketball Achievements (since graduation from high school and/or college, include coaching records, awards,
accomplishments, and/or professional playing stats, records, awards and accomplishments)
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
13. High School and College Extra-Curricular Activities:_________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
14. Height and Weight in playing days __________________ Lbs. __________________Ft. ________________________In.
15. Employment since graduation (list yrs.)
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
16. Present Position: ______________________________________________________________________________________________
Firm__________________________________________________________________________________________________________
Address ______________________________________________________________________________________________________
17. Marital Status (Name of Spouse) _______________________________________ Maiden Name ______________________________
Home Town ___________________________________________________________ State ___________________________________
18. Children (List Names and Year of Birth) ____________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
19. Hobbies ______________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
20. Thoughts on Winning ___________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
21. What Impact has Basketball had on your Life? ______________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
22. Additional Information or Comments ______________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
IMPORTANT
PLEASE ENCLOSE A CURRENT PHOTO OF CANDIDATE,
AND AT LEAST ONE CANDID OR ACTION PHOTO OF
CANDIDATE FROM PLAYING OR COACHING DAYS
(This page to be completed by High School, College, Organization, or Individual Submitting Application)
PLEASE TYPE OR PRINT
1. Individual or Organization ____________________________________________________________________________
2. Address __________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
3. Present Occupation _________________________________________________________________________________
4. Athletic Affiliation __________________________________________________________________________________
5. Supplemental Documentation: Copies of any supporting materials are welcome to accompany this nomination
form.
_________________________________________________________
(Signature of individual making nomination)
(Date)
(Note: If additional space is needed, please use plain sheet of white paper, 8½ × 11 inches, write on one side only,
preferably typewritten.)
Indiana Basketball Hall of Fame
Phone (765) 529-1891
Fax (765) 529-0273
Email: info@hoopshall.com
Return to:
Indiana Basketball Hall of Fame
One Hall of Fame Court
New Castle, IN 47362