2023 Hall of Fame Nomination Form

Select an award category*

AthleteNon-Athlete

Nominee Name*

Address*

Street Address

Street Address Line 2

City State

Zip Code

Phone Number*

Please enter a valid phone number.

Nominee Email*

example@example.com

Nominated by*

Nominator Email*

example@example.com

Prerequisites

• Participation for at least 15 years, with at least 10 of those years being with Special Olympics Missouri.
• Not a present employee or spouse of a present employee of Special Olympics Missouri.
• Not a current SOMO board member.
• Demonstrates behavior and conduct associated with integrity and good sportsmanship.
• For athletes: Demonstrates a significant positive impact within the Special Olympics movement.

Years in Missouri*

Years in another state*

Enhancements

Medal winner at a National Games/World Games:

State Athlete of the Year (enter year):

Area Athlete of the Year (enter year):

Please list all sports athlete has participated in:

Athlete Leadership Program (ALPs)

Background

List areas of involvement (i.e., Public Education, Coaching, Games Management, Development, Outreach) with SOMO to include years, if possible:*

How has the nominee's participation impacted Special Olympic Missouri's program?*

Please include a brief narrative stating why you believe the nominee is deserving of induction into the Special Olympics Missouri Hall of Fame.*

Please attach supporting documentation (photograph of nominee required).

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