Name of Person Being Nominated:

(Include name of surviving relative in parentheses if person being nominated is deceased)

Address of Person Being Nominated (or Surviving Relative if Deceased):

    Street:     

    City:       State:     Zip:

Did This Person Graduate From Henry Clay High School?

  Yes    No

If Yes, What Year?

Briefly list specific accomplishments of nominee that would warrant induction into the Henry Clay High School Hall of Fame:

Name of Person Submitting Nomination:

Address of Person Submitting Nomination:

    Street:     

    City:       State:     Zip: