Port Byron Central School Alumni Hall of Fame Nomination Form

Name of Nominee __________________________________________________________ Address of Nominee, if living _______________________________________________

Year of Graduation ________________ State ___________ Zip ____________

Phone Number of Nominee (if known) _( _____)_______________ Email of Nominee (if known) ___________________________ Nominated by ______________________________ Your Phone # (_____)____________ Your Email________________________ Your Address __________________________________________________________ State _____________ Zip ____________

Hall of Fame committee will receive nominations by March 31 of each year. Nominations will be checked, screened and approved by the committee. Members of the Alumni Association present at the Annual Alumni Banquet will vote on submitted names. The candidate(s) with the highest number of votes will be announced and installed the following year. Individuals who are not graduates of Port Byron Central School will be considered in light of special circumstances i.e. graduation interrupted by military service and death, however this is an Alumni honor, other worthy individuals can be honored by the Carnegie Institute, Chamber of Commerce, United States Congress, etc. We are the only PBCS Alumni Association! Nominees may be submitted at anytime. If received before March 31, they will be considered for that year. Names placed in nomination may be considered in future years, if not selected in the year of nomination. Nominations may be sent to: Joni Lincoln 10376 State Route 38 Port Byron, NY 13140

Describe achievement of nominee/Details supporting the nomination: (Feel free to enclose copies of newspaper clippings, awards, and other documentation, use additional sheets if needed) :

Criteria: Please insert a check mark for all that apply about the nominee: ___ Graduate of Port Byron Central School ___ Performed significant community service, service to humanity or social contribution ___ Distinguished in occupation/vocation ___ Worthy character More forms will be available at the Alumni Banquet Revised 01/23/2013