OHSVCA Milestone Award Nomination Form

Name*
First Last
Nominee Email*
Year of Nomination
OHSVCA District Number*
Total years as a head coach*
Years as other type of coach (specify)
OHSVCA Member*
- Yes
- No
Lifetime Member*
- Yes
- No
Years of being OHSVCA member*
Current/Last School Coached*
School Name Address City State ZIP Code
School Phone*
Career Coaching Record*
Ohio Coaching Record ONLY
School Level Years Dates Wins Losses
Total record at ONLY the level you are applying*
Wins Loses
Mark the following that you are applying*
- 100 wins
- 400 wins
- 700 wins
- 200 wins
- 500 wins
- 800 wins
- 300 wins
- 600 wins
- 900 wins

School	Level	Years	Dates	Wins	Losses