Individual/Organization Submitting Nomination

Name(required)

Phone

Street Address

City, State, Zip Code

Email (required)

Headshot

PreviousContinue

Nominee Profile

Nominee Category(required)

PlayerCoachRefereeAdministratorMeritorious (sponsor, employee, volunteer, etc)

Nominee Name(required)

Nominee address

Nominee Email

Nominee date of birth

State or National Affiliation

Nominee Affiliation, city/state

Is the nominee still active in soccer?

YesNo

Nominee Spouse or closest living relative

Address

Phone

BackContinue

Nominee Resume

List the nominee’s contributions to NYSA in chronological order

Resume

Back