Riverview Sports Wall of Fame Athlete/Builder Form

Riverview Sports Wall of Fame

Nomination Form for Athletes and Builders
Instructions for Nominating

To nominate an individual, please fill out the form and include as much background information as possible. This must include pictures, newspaper clippings, etc.

Please review the entire form before filling it out to ensure you have all of the information prepared.

If the nomination is posthumous, you must receive permission from the next of kin to complete this form.
Eligibility of Nomination:

ATHLETE is defined as an individual from the Town of Riverview who has played for or brought fame to the Town of Riverview, who has excelled in one or more sports with distinction. The athlete must have competed at national or international levels. Amateur and professional athletes are included in this category. Individuals who have played for teams outside Riverview and have won provincial, national, or international championships will be considered under this category.
- Athletes are eligibile for nomination 3 years after their last active competition in the sport(s) they have been nominated for.
- An active athlete may be eligible if they have reached the age of fifty (50) years.
- Certain extenuating circumstances may alter consideration (i.e. illness).
BUILDER is defined as any individual, group, association or family which has made a major contribution toward the promotion, development and advancement of amateur sport in the Town of Riverview. This may include officials, managers, trainers, coaches, physical educators, sports journalists, broadcasters, administrators, and executives of athletic clubs, groups and associations.
- Builders may be active or retired at the time of nomination.
Nomination Category:*

AthleteBuilder
NOMINEE'S PERSONAL INFORMATION
Name:*

First NameLast Name
Nickname (if any):
Place of Birth:*
Date of Birth:*

MonthDayYear
Date
Current Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:
example@example.com
Phone Number*
Please enter a valid phone number.
Dates of Residency in Riverview:*
High School:*
University/College/Other:
Spouse's Name:
Children's Names & Ages:
i.e. John Smith (Age 23)
Present or Most Recent Occupation:*
Is this a posthumous nomination?*

YesNo
Date of Death:*

MonthDayYear
Date
Place of Death:*
i.e. Moncton, NB
Next of Kin:*
Relationship to Nominee:*
Phone Number:*
Please enter a valid phone number.
Email:
example@example.com
CAREER INFORMATION

Competitive sports in which the nominee was involved as a player or builder.
Primary Sport (list sport, team, league, dates of participation):*
i.e. Volleyball, Team New Brunswick, Nationals, 2005-2006
Secondary Sports (list sport, team, league, dates of participation):*
i.e. Volleyball, Team New Brunswick, Nationals, 2005-2006; JV Basketball, Riverview High School, 2001 - 2004;
If retired from competition, what was the last year in which the nominee competed?*
What function best identifies the nominee's contribution to sport?*

AdministratorOfficialTechnicianCoachEducatorOrganizerSponsorPatronOther
Outstanding Performances- Specify the level of competition i.e.: Olympic, World, Commonwealth, Pan American, International, National, Atlantic, Maritime, Provincial or Municipal. Include placement in stated competitions – 1st, 2nd, etc. and the number of times the nominee competed in each competition.*
Awards & Recognition- List the nominee's personal awards. Include dates and relevant information.*
i.e. Medals (provincial, national, international competitions), Records, Trophies (MVP, Top Scorer etc.), All-Star Selection, Athlete Of The Year, Admission To Other Walls / Halls Of Fames, Post Participation Recognition etc.
Contribution Over Time- Provide information to illustrate the nominee's involvement with, and dedication to, sport over time. *
i.e. Number of years service at each level, various positions held, etc.
Commitment and Perseverance- Provide information to illustrate the nominee's personal commitment, and his/her perseverance on behalf of the sport. Include any unusual or difficult circumstances which have made the contributions noteworthy.*
Personal Attributes- Provide information on the nominee's leadership skills, character, sportsmanship, other areas of community service, the ability to work well with others and other personal qualities.*
Any additional information which you consider pertinent to the nomination.
PHOTOS & ARTICLES
I want to submit photos and articles supporting my nominee:*

In person at 55 Biggs Drive. Staff will borrow your original copies to scan and will return to the nominator upon completion.OnlineIn person and online
Upload all photographs here:*

Cancelof
Upload all newspaper articles here:*

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NOMINATOR INFORMATION
Name of individual submitting the nomination:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
I hereby declare that to the best of my knowledge all of the above information is accurate and correct.*

Clear
Should be Empty:

Riverview Sports Wall of Fame

NOMINEE'S PERSONAL INFORMATION

CAREER INFORMATION

PHOTOS & ARTICLES

NOMINATOR INFORMATION