Nominate Your Senior Athletes for Republic Bank Athlete of the Month

NOMINATION FORM

Republic Bank Athlete of the Month

Name of Nominee: ____________________________

School:_______________________________________

Graduation Year: _____________



Cumulative GPA: (minimum 2.5)_________________

Varsity Sport Participation: ____________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Activities and qualities demonstrating leadership/Comments from nominator:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Nominated by: __________________________________________________________________________

Title: ____________________________________________________________________________________

Athlete Contact Information:

Phone: _____________________________________________________________________________

Mailing Address: __________________________________________________________________

_____________________________________________________________________________________

Send completed form to: editor.greaterlouisville@vype.com

or fax to 502-454-8339

If you have a head shot photo available of the athlete, we would appreciate receiving that as well.

Thank you for your nominations. We will advise you if your athlete is chosen.