MALE/FEMALE ATHLETE OF THE YEAR NOMINATION
This form may be forwarded as E-mail, appropriate E-mail forwarding information from members on page 2 blocks VI-X will be considered substitute for
signatures.
In reference , please consider the following individual
10000111
I. ATHLETE’S DATA
NAME (Last, First, Middle initial)
RANK/GRADE
SEX
DUTY STATUS: Active Reserve
EAS:
UNIT
BASE
SPORT
DATE OF BIRTH (YYYYMMDD)
EMAIL ADDRESS:
PRESENT HOME ADDRESS (Street, City, State, & Zip Code)
WORK NUMBER OR DUTY PHONE (Include area code)
CELL PHONE:
II. MILITARY DATA
DUTY TITLE
MOS
TIME ON STATION
PENDING PCS/TDY
Du
III. ENDORSERS SIGNATURE BLOCK
TYPED NAME & GRADE
SIGNATURE
By signing above, it is understood that this nomination must go through the Installation’s Athletic Director. If you are at a location
without an athletic director, forward the nomination directly to Manpower and Reserve Affairs, MRS-2. I certify that all
information may be subject to verification and if false, my application will not be considered for participation.
IV. REFERENCES- (Two required-List name, title, email, phone)
V. SPORTS EXPERIENCE
ATHLETE
LOCATION
SPORT
DATES OF COMPLETION
AWARDS RECIVED/NOTABLE
ACCOMPLISHMENTS
HIGH SCHOOL
COLLEGE
CIVILIAN
MILITARY
VI. SIGNIFICANT PERFORMANCES FOR THE PAST 3 YEARS
EVENT
LOCATION
DATE
RESULTS
VII. PRIVACY STATEMENT
Authority to request this information is derived from 10 USC 5031, the purpose of which is to assist in the identification and selection of individuals qualified to
train for higher levels of sports competition. This information will be used by the Marine Corps Sports Office in determining those individuals with the highest
qualifications for further training and competition. However, if requested information is not provided, individuals concerned may not be selected for this training or
competition.
I CERTIFY THAT ALL OF THE INFORMATION AND DATA PROVIDED IS CORRECT AND TRUE AND THAT I HAVE READ AND UNDERSTAND
THE PRIVACY ACT STATEMENT
______________________________ _________________
Signature of Nominee Date
VIII. ATHLETIC DIRECTOR BLOCK
ATHLETIC DIRECTOR
E-MAIL ADDRESS
INSTALLATION
TYPED NAME
SIGNATURE
PHONE
DATE
X. COMMENTS (Use another sheet if necessary)
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signature
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