All forms must be submitted within three weeks of program/event.
Type of Program/Event:
INDIVIDUAL Personal Development (50 pts) Professional Development (50 pts) Community Service (50 pts)
TEAM Personal Development (100 possible pts) Professional Development (100 possible pts) Community Service (200 possible pts) Athletes Supporting Athletes (100 possible pts)
The 'Extra Mile' (50-100 possible pts)
Date of Program/Event: Month January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2010 2009 Number of Participants: Amount of Time Spent:
Sport: Select Sport Baseball Basketball-Men Basketball-Women Cross Country/Track and Field - Men Cross Country/Track and Field-Women Field Hockey Football Lacrosse Soccer-Men Soccer-Women Softball Swimming Volleyball Wrestling
Submitted By:
Email:
Name and Description of Program/Event:
Comments:
