Canton High School

Wall of Fame

Nomination Form

2006

Nominees for the Wall Of Fame Must:

v Be a Canton High School graduate who earned a diploma before 1996.

v Have made significant contributions to the community (Canton or current community) and/or their chosen field of work.

v Remains a citizen in good standing.

I Nominate The Following Person:

Name __________________________________________ Year of Graduation ____________

Maiden Name (if possible)__________________________

Home Address _________________________________________________________________

City _______________________________ State: ______ Zip Code ___________________

Phone (day) ( ) _______________________ (evening) ( ) _______________________

This Nomination is Made Because: (you may attach a separate piece of paper) ______________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Nomination Submitted By:

Name _________________________________________________________

Address _________________________________________________________

City/State/Zip _________________________________________________________

Phone (Day) ( )___________________ (Evening) (___)_____________________

Email Address ____________________________________________________

Please Return This Form To:

Canton High School

Wall of Fame Nomination Form

c/o Dr. Jordan E. Grossman, Assistant Principal

76 Simonds Avenue

Canton, CT 06019

(860) 693-7707

You may also email nomination forms to:

jgrossman@cantonschools.org

Deadline for Nominations: July 1, 2006