Fort Defiance High School
“INDIANS”
Hall of Fame Application
PURPOSE and REQUIREMENTS
The INDIAN HALL OF FAME will honor those individuals who have made
significant contributions to the FORT DEFIANCE Athletic Program. Athletes,
administrators, coaches, and members of the FORT community are eligible for this
honor and recognition.
CRITERIA FOR SELECTION
Athlete:
 Achievement or leadership in athletics based on:
- Post season honors such as all state, all region, and all district teams
- Record-setting performances
 Post graduation achievements shall be considered:
- Outstanding amateur or professional performance in a sport
- Achievement in coaching or training of athletes
Contributor:
 Contributions to Society and leadership in:
- Fort Defiance High School Activities
- Achievement in other sports related fields such as sports journalism or
broadcasting
 Community activities shall be considered
SELECTION PROCESS
Each year the committee may select up to 4 new members for induction into the
Athletic Hall of Fame. Anyone can nominate an individual by filling out the
application that highlights the character and accomplishments of their nominee. A
selection committee will review all applications each and vote on the Class to be
inducted. The Induction Ceremony will include a reception on Friday night and
introduction at the football game, dinner on Saturday evening to honor the new
Inductee Class, and a copy of the HALL PLAQUE. Extra plaques may be purchased
at cost.
APPLICATION
The deadline for filing the Application Form is December 31st of any year. For an
application to be considered complete, the following information MUST be
completed. Incomplete applications will not be reviewed during the voting process.
Previous nominations will be reviewed each year and need not be resubmitted.
Upon Completion, please return the Application form to:
Fort Defiance High School
Athletic Department
195 Fort Defiance Road
Fort Defiance, VA 24437
Nominating an athlete?? Pages 1, 4, 5, 6
Nominating a coach?? Pages 1, 2, 3, 6
Nominating a contributor?? Pages 1, 2, 3, 6
Page 1
CONTACT INFORMATION OF INDIVIDUAL SUBMITTING APPLICATION FORM:
*Full Legal Name:
___________________________________________________________________
*Street Address:
_________________________________________________________________
City:_________________________
State: __________ Zip: _______________
*Home Phone:_______________________________________________________
*Cell Phone: _______________________________________________________
*Work Phone: ______________________________________________________
*Other contact number: _______________________________________________
*Email Address:_____________________________________________________
*Can you provide a picture of your nominee (past or present)? If your nominee is
selected, the picture would be used to make the plaque and will be returned.
*Would you like to be notified? ___________
I would like to nominate___________________________ for the INDIAN HALL OF FAME.
NOMINEE’S PERSONAL INFORMATION:
*Nominee (Full Legal Name):
_________________________________________________________________________
*Nominee’s Email Address:
_________________________________________________________________________
*Nominee’s Home Phone:
_________________________________________________________________________
*Nominee’s Cell Phone: _____________________________________________________
*Nominee’s Mailing Address: ________________________________________________
*City:___________________________
State:___________ Zip: _______________
*Nominee’s Date of Birth: ___________________________
_________________________________________________________________________
*Nominee’s Date of Death (if applicable): _______________________________________
________________________________________________________________________
*Approximate Date (s) of Participation at Fort Defiance High School Sports:
_________________________________________________________________________
*Approximate Date (s) of Participation in College and name of College Attended:
_________________________________________________________________________
Page 2
Coach/Administrator/Contributor Nomination Form
Person nominated: _______________________________________________
- Contributor -
- Coach -
-Administrator-
Years coached or contributed at FDHS ________________
Sports or activities:
__________________________________________________________________________
______________________________________________________________
Colleges Degrees Earned and Institution(s):
____________________________________________________________________
High School Graduated from: ______________________ City:_________________ State:
_________
FDHS Coaching:
Sport: __________________ Years: ________________________
Record: _______________
District/Conference Titles: _______________________
Regional Titles: ___________
State Titles: _________________________________________________
Sport: __________________ Years: ________________________
Record: _______________
District/Conference Titles: _______________________
Regional Titles: ___________
State Titles: _________________________________________________
Sport: __________________ Years: ________________________
Record: _______________
District/Conference Titles: _______________________
Regional Titles: ___________
State Titles: _________________________________________________
NOMINEE’S CONTRIBUTION TO SPORTS:
Describe Nominee’s contribution to sports in the following areas and attach additional pages if
necessary.
1. Volunteer Youth Activities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. Coaching as a Profession:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Page 3
3. Administration:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4. Media or Public Relations:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Sponsorships of Athletic Groups or Events:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6. Officiating:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
7. Community Service Activities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
8. Other Relevant Data:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
OTHER NOMINEE INFORMATION:
Please describe the nominee’s personal character traits. You may describe how the nominee is a
positive role model, and active member in the community, shows a continuing dedication to sports,
or any other information about the nominee’s character you feel is relevant. Attach additional pages
if necessary.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
References
A total of three reference letters may be submitted along with each application.
Letters should describe applicants athletic and/ or community service activities as
related to this nomination.
To allow for proper consideration of all applications, only those received prior to
January 1st of any year will be processed and judged for the next induction class.
Thank you for your participation in this award of Honor. If you have any
questions, please contact Mark Mace, Activities Director at (540) 245-5050 (school)
or (540) 294-2448 (cell), or email: mace.pm@augusta.k12.va.us
Page 4
Athlete Nomination Form
Person nominated: _________________________________________________
Year graduated from FDHS __________________________
Colleges Degrees Earned and Institution(s):
_________________________________________________________________
High School Athletic Accomplishments
To be considered as an athlete, nominees must have achieved at least one of the
following. Please be specific.
All-America or National Ranking:
___________________________________________________________________
First or Second Team All-State in a Team Sport (team, sport, and year):
___________________________________________________________________
First Team All-Conference in a Team Sport (team, sport, year):
___________________________________________________________________
State Champion in an Individual Sport:
___________________________________________________________________
State 2nd or 3rd in an Individual Sport:
___________________________________________________________________
Regional and/or District Champion in an Individual Sport:
___________________________________________________________________
Exceptional Performance in a Sport(s) (state, league or school records):
___________________________________________________________________
High School Awards and Achievements
Sport(s) and Year(s):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Team Captain
Indian Award
Other Award
Year
Year
Year
_________
_________
_________
_________
_________
_________
_________
_________
_________
_________
_________
_________
GPA _________ -- Valedictorian -- Salutatorian
Team
Sport_________________
Sport_________________
Sport_________________
Sport_________________
Scholastic Achievements:
SCA/Class Office(s):
____________________________________________________________________
Non-School Sports & Achievements:
____________________________________________________________________
____________________________________________________________________
Page 5
College Athletic Accomplishments – These shall be considered, they are not a
requirement.
College:
___________________________Sport:_________________________
Position(s): ________________ Years: ___________________________________
College:_____________________________Sport:____________________________
Position(s): ________________ Years: ___________________________________
Sport(s) and Year(s):
____________________________________________________________________
All-American or national ranking:
____________________________________________________________________
National meet placing:
____________________________________________________________________
All-conference (note if first or second team):
____________________________________________________________________
Conference champion in an individual sport:
____________________________________________________________________
Conference meeting placing:
____________________________________________________________________
Regional and/or district placing in an individual sport:
____________________________________________________________________
Exceptional performance in sport(s) (national, conference or school records):
______________________________________________________ ______________
Conference and team awards (captain, MVP, inspirational, scholastic, etc.):
____________________________________________________________________
Other athletic achievements or awards:
____________________________________________________________________
Professional Athletic Accomplishments
Professional team(s) played for:
___________________________________________________________________
Pro athletic achievements:
____________________________________________________________________
To allow for proper consideration of all applications, only those received prior to
December 31st of any year will be processed and judged for the next induction class.
Thank you for your participation in this award of Honor. If you have any
questions, please contact Mark Mace, Activities Director at (540) 245-5050 (school)
or (540) 294-2448 (cell), or email: mace.pm@augusta.k12
Page 6
NOMINEE’S CONTRIBUTION TO SPORTS:
Describe Nominee’s contribution to sports in the following areas and attach additional pages if
necessary.
1. Volunteer Youth Activities:
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________________________________
2. Coaching as a Profession:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. Administration:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4. Media or Public Relations:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Sponsorships of Athletic Groups or Events:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6. Officiating:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
7. Community Service Activities:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
8. Other Relevant Data:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
OTHER NOMINEE INFORMATION:
Please describe the nominee’s personal character traits. You may describe how the nominee is a
positive role model, and active member in the community, shows a continuing dedication to sports, or
any other information about the nominee’s character you feel is relevant. Attach additional pages if
necessary.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
To allow for proper consideration of all applications, only those received prior to
December 31st of any year will be processed and judged for the next induction class.
Thank you for your participation in this award of Honor. If you have any questions,
please contact Mark Mace, Activities Director at (540) 245-5050 (school) or (540) 2942448 (cell), or email: mace.pm@augusta.k12.va.us