Fillmore High School Academic & Career Hall of Fame Nomination Form

Mission: The Fillmore High School Academic & Career Hall of Fame is to recognize those who
have demonstrated significant accomplishments based upon academic excellence &
achievement, career accomplishments, community service, personal excellence & dedication to
lifelong learning.

Nominees will be recognized for a high level of achievement in a combination of:  academic
endeavors,  career excellence  service to community

The nominee should also exemplify personal commitment to:  good character  scholarship 
leadership  service within his/her field of expertise

Nominees must have graduated from Fillmore High School, be at least 30 years of age and in
good standing with the Fillmore Unified School District.

Submitted by:
Name:
Phone: Email:

Nominee Name:
Phone: Email:
Fillmore High School Graduation Year:

Accomplishments (Awards, Honors, Extracurricular Activities)

Educational Accomplishments (College, Graduation Year, Degree, Awards, Extracurricular)
______________________________________________________________________________
______________________________________________________________________________
______________

Employment History & Accomplishments (Awards & Honors) Professional Awards, Honors &
Achievements, Community Service / Philanthropy/ Military Service (Years of Active Duty,
Awards)
______________________________________________________________________________
______________________________________________________________________________
______________

Nomination deadline is June 28th, 2018

Hall of Fame Inductees will be recognized at Back to School Night
Nominators Signature: Date:
Send the completed form to:
Barbara Lemons
Fillmore High School
555 Central Ave
Fillmore, CA 93015