Phil Womble Ethics in Sports Award Information Form

Congratulations on being selected as the recipient of the Phil Womble Ethics in Sports Award from your school. Please complete the form below and hit “submit”. The information will be used to introduce you during the press luncheon and given to the news media.

On the day of the event your picture will be taken by the press. The award’s sponsor, Dave Pintard of the Pintard Group, will interview you just before he presents you with your award which is usually at the beginning of the luncheon. Upon receipt, verbal acceptance by you is encouraged. We invite your parents to attend.

Date*
MM slash DD slash YYYY
Name*
First Last
School*
Scholar-Athlete's Email*
Address*
Street Address City State ZIP Code
Home Phone (###) ###-####*
Mobile Phone (###) ###-####
Parents
Father's Name
First Last
Father's Phone
Mother's Name
First Last
Mother's Phone
Athletic Background
Sports Participated In*
Captain of
Records, Awards, First Places
Other Elements of Sports History
Unique Experiences in Sports
Future Athletic Plans
Academic Background
Grade Point Average (GPA)
Current Courses
Academic Honors
Academic Interests & Unique Experiences
Future Academic Plans
Other School or Community Involvement
List Any School or Community Activities
Miscellaneous
Those attending with you.
Athletic Director – Name
Coach – Name
Other – Name
Scholar Athlete Signature*

I hereby agree to release to new media the information recorded on this form. (Enter your name.)

Phil Womble Ethics in Sports Award Information Form

Phil Womble Ethics in Sports Award Information Form

Parents

Athletic Background

Academic Background

Other School or Community Involvement

Miscellaneous

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