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Nominee Information

Name of Nominee:
First:
Last:
Maiden(if applicable):

Please Choose:
If deceased, please indicate name of person to receive information, and their relationship, and place their address in the box:

Current Address:
City:	State:	Zip:

Canon-McMillan Graduate(not a requirement):		Year of Graduation:

Telephone Number:
E-mail Address :

Area of Nomination:

Nominator Information

Name of Nominator:
First:
Last:

Current Address:
City:	State:	Zip:

Canon McMillan Graduate(not a requirement):		Year of Graduation:

Telephone Number:
E-mail Address :

The deadline for accepting nominations is August 1, 2012

Nominations should be mailed to or submitted electronically:
A paper form can be accesed by clicking HERE.

Canon-McMillan Hall of Honor - Attention Mrs. Berry
Canon-McMillan School District
1 North Jefferson Ave.
Canonsburg, PA 15317

Notes:

*Nominees MUST be at least thirty (30) years of age. For those nominees who are deceased, the age requirement is waived.

*Nominee verifications will be conducted.

*This nomination is valid only for one year.

Canon-McMillan School District Hall of Honor Nomination Form www.cmsd.k12.pa.us