PENNSYLVANIA WRESTLING COACHES ASSOCIATION HALL OF FAME INDUCTEE’S INFORMATION FORM

Name _________________________________________________________________________

Mailing Address __________________________________ City __________________________

State __________ Zip ______________________________ Phone (_____)__________________

Email Address __________________________________Cell Phone (_____)________________

High School ____________________________________ Graduation Year _________________

College ________________________________________ Graduation Year _________________

Graduate School ________________________________ Graduation Year _________________

Graduate School Major ___________________________________________________________

List High School Record and Accomplishments:

List College Wrestling Record and Accomplishments:


 

Post- Collegiate Wrestling (YMCA, AAU, USA Wrestling):

Coaching Information

H. S.’s Coached _________________________ W-L Record _____________ Years__________

College’s Coached _______________________ W-L Record _____________ Years _________

Other Wrestling Activities (Officiating, etc.):

Present Occupation ________________________ Company ____________________________

Send to:  Norm Palovcsik                                             npalovcs@oak.kcsd.pa.us

               Central Mountain Middle School                   Phone: (570) 295-3795

               200 Ben Ave.                                                 Fax: (570) 726-7227

               Mill Hill, PA 17751