Adena Sports Medicine Athlete of the Month Nomination Form

Program is open to high school seniors who reside in one of the following counties: Adams, Fayette, Gallia, Highland, Hocking, Jackson, Pickaway, Ross, Scioto and Vinton. Student-athlete must have at least a "B" average in all subjects and excel on the athletic field.

Please complete form

Student Nominee *This question is required.

Student Phone Number *This question is required.

Student Email Address *This question is required.

Sport *This question is required.

Cumulative GPA *This question is required.

School *This question is required.

Nominator *This question is required.

Nominator Phone Number *This question is required.

Nominator Email Address *This question is required.

School Sponsor (Parent/Guardian nominations must be sponsored by a school official - Athletic Director, principal, coach, or counselor) *This question is required.

I acknowledge that this student athlete is a high school senior

Photo of athlete nominated

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Please describe the student-athlete's interscholastic athletic accomplishments, including acts of sportsmanship: *This question is required.

Please describe how the nominee demonstrates leadership at school and in the community: *This question is required.

Please describe the nominee's commitment to academics and noteworthy achievements: *This question is required.

I understand that nomination forms will only be considered if a parent/guardian has signed a consent form. You can email the consent form to a parent/guardian. *This question is required.

Yes, I understand.