Athletic Hall of Fame Online Nomination Form

To nominate someone for Athletic Hall of Fame, this form must be filled out in its entirety and you must submit a recent high-resolution, headshot photograph of the nominee (at least 300 dpi and .jpg format).

If you need a printable form, please contact Maria McLeod at mmcleod@eccc.edu or 601-635-6303.

Applications are good for five consecutive years.
Additional information about nominees is encouraged. Please attach the information to this form. Selection is based primarily on materials submitted.

The fields marked with * are required.

Name of Nominee *

Maiden Name *

Email *

Address *

City *

State *

Zip *

Home Phone *

Work Phone *

Cell Phone *

High School Graduated From *

County *

Senior College/University Attended/Graduated From *

Years *

Sports Lettered In and Honors Received In Community College *

Sports Lettered In and Honors Received At Senior College/University Level *

WORK EXPERIENCE

1-Work Experience Place *

1-Position *

1-Dates *

2-Work Experience Place *

2-Position *

2-Dates *

3-Work Experience Place *

3-Position *

3-Dates *

Contributions to College/and to Community *

Professional Affiliations and Honors *

FAMILY

Spouse *

Spouse Maiden Name *

Did spouse attend EC? *

Yes

If spouse did attend, what years attended/graduated? *

Children & Ages *

Any additional information may be mailed to the address below or uploaded below.

Alumni Association
East Central Community College
P.O. Box 129
Decatur, MS 39327-0129
Ph: 601-635-6327

Click below to upload additional information you would like to attach to this form.

Upload File-1 *

Files must be less than 20 MB.
Allowed file types: jpg jpeg pdf doc docx xls xlsx.

Upload File-2

Files must be less than 20 MB.
Allowed file types: jpg jpeg pdf doc docx xls xlsx.

Upload File-3

Files must be less than 20 MB.
Allowed file types: jpg jpeg pdf doc docx xls xlsx.

Upload File-4

Files must be less than 20 MB.
Allowed file types: jpg jpeg pdf doc docx xls xlsx.

Nominator's Name *

Nominator's Email Address *

Nominator's Cell Phone Number *

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Athletic Hall of Fame Online Nomination Form

To nominate someone for Athletic Hall of Fame, this form must be filled out in its entirety and you must submit a recent high-resolution, headshot photograph of the nominee (at least 300 dpi and .jpg format).

If you need a printable form, please contact Maria McLeod at mmcleod@eccc.edu or 601-635-6303.