(Please type or print clearly)

LAST NAME: ___________________________________________________________

FIRST NAME: ___________________________________________________________

NICKNAME: ____________________________________________________________

ADDRESS: _____________________________________________________________

PHONE: ________________________________________________________________

DATE OF BIRTH: ________________________________________________________

PLACE OF BIRTH: _______________________________________________________

CITIZENSHIP OR COUNTRY REPRESENTED: ______________________________

IF DECEASED, DATE OF DEATH: _________________________________________


PLEASE INDICATE THE CATEGORY OF THE NOMINEE:


	__________ SWIMMER

	__________ DIVER

	__________ WATER POLO PLAYER

	__________ SYNCHRONIZED SWIMMER

	__________ COACH

	__________ CONTRIBUTOR (Point of Service)



Complete the following items with as much detail as possible.  Be specific to your sport.
Coaches list your athletes who competed in each of the areas.  Use additional paper if
needed.


I.  OLYMPIC HISTORY

Medals attained:					Gold __________

Coaches list total number of medals 		      Silver __________
attained by their athletes
						      Bronze __________

					Other final placings __________


A. CHRONOLOGICALLY LIST THE OLYMPIC GAMES IN WHICH THE 
NOMINEE PARTICIPATED:  Include events, relays, strokes, times, records
established, games, goals scored, position, honors received, results, etc.





B. COACHES AND CONTRIBUTORS LIST INVOLVEMENT WITH EACH OF
THE GAMES:  Include position(s) held, etc.  For example - coaching, managerial,
administrative, etc.







II.  WORLD RECORD HISTORY


	Number of individual World Records attained: _________________

	Number of relay World Records attained: _____________________

	(Coaches list total number of World Records attained by their athletes)


A. CHRONOLOGICALLY LIST EACH WORLD RECORD SET:  Include
event, time, date, location, etc.  Coaches lit their athletes and records.










III.  WORLD CHAMPIONSHIP HISTORY

Number of Medals attained:				Gold __________

(Coaches list total number of medals 		      Silver __________
attained by their athletes)
						      Bronze __________

					Other final placings __________


A. CHRONOLOGICALLY LIST THE WORLD CHAMPIONSHIPS IN WHICH
THE NOMINEE PARTICIPATED:  Include, events, relays, results, times, records
established, games, position, goals scored, honors received, etc.  Coaches list their
athletes who competed and results.





B. COACHES AND CONTRIBUTORS LIST PERSONAL INVOLVEMENT WITH
EACH OF THE CHAMPIONSHIPS:  Include positions held, etc.  For example - 
coaching, managerial, administrative, etc.







IV.  NATIONAL CHAMPIONSHIP AND NATIONAL RECORD HISTORY

	Number of National Championships attained:	__________

	Number of National Records set:			__________

	(Coaches list total number of national championships
	 and records attained by their athletes)


A. CHRONOLOGICALLY LIST EACH NATIONAL CHAMPIONSHIP
ATTAINED:  Include events times, scores, dates, locations, games, position, goals
scored, honors received, etc.





B. INDICATE FROM "A" ABOVE, WHICH WERE NATIONAL RECORDS:





C. COACHES LIST THE YEARS AND MEETS IN WHICH TEAMS WON A
NATIONAL TEAM CHAMPIONSHIP: Include title, score, date, location, etc.






V.  HISTORY OF:

	(Check 1 per page)
				__________ Commonwealth Games

				__________ Pan American Games

				__________ European Championships (LEN)

				__________ Asian Games

				__________ Other ____________________


Number of medals attained:
(Coaches list number of medals attained by their athletes)

				Gold __________

			        Silver __________

			        Bronze __________

		  Other final placings __________


A. CHRONOLOGICALLY LIST EACH EVENT: Include relays, times, records
establishes, games, position, goals scored, honors received, results, etc.





B. COACHES AND CONTRIBUTORS LIST PERSONAL INVOLVEMENT WITH
EACH OF THE GAMES: Include positions held.  For example - coaching, 
managerial, administrative, etc.







VI.  UNIVERSITY, COLLEGE, OR SCHOOL COMPETITION
HISTORY

	Number of collegiate National Championships attained: __________


A. CHRONOLOGICALLY LIST UNIVERSITY OR COLLEGE NATIONAL
CHAMPIONSHIPS ATTAINED:  Include events, relays, times, records 
established, games, position, goals scored, results, honors, etc.





B. LIST NAMES OF COACHES UNDER WHICH THE NOMINEE SWAM,
DIVED, PLAYED OR PERFORMED:  Include dates, team and location.





C. COACHES LIST THE YEARS AND MEETS IN WHICH TEAMS WON A
NATIONAL TEAM CHAMPIONSHIP:  Include title, score, date, location, etc.







VII.  LIST SPECIAL HONORS AND AWARDS RECEIVED:







VIII.  LIST INTERNATIONAL AND NATIONAL 
ORGANIZATIONS AND ASSOCIATIONS ON WHICH THE NOMINEE
SERVED OR WAS APPOINTED







IX.  LIST "MILESTONE" ACHIEVEMENTS OR "FIRSTS" IN
THE SPORT WHICH WERE OBTAINED BY THE NOMINEE:







X.  ADDITIONAL INFORMATION OR DIALOGUE WHICH IS 
HELPFUL IN PREPARING INFORMATION FOR THIS HONOREE:











						Submitted by:

						_________________________
						Print Name

						_________________________
						Signed

						_________________________
						Date

						_________________________
						Telephone