Blue KC Sporting Samaritans Nomination Form
Name (Nominator)
First Name
Last Name
E-Mail Address
*
Phone Number
*
Nominee Information
Name
*
First Name
Last Name
E-Mail Address
*
Phone Number
*
Is your nominee a student, teacher, or teacher/coach?
*
Student
Teacher
Teacher/Coach
Other:
If they are a student, teacher, or teacher/coach, what is your school name and grade?
Explain in 250 words or less why your nominee should be selected as a "Blue KC Sporting Samaritan"
*
To the best of your knowledge, is this person recognized as an outstanding student/educator and person of good character by other students/colleagues?
*
Yes
No
The nominee is willing to be included in a press release if selected
*
Yes
The nominee lives within 75 miles of Children’s Mercy Park
*
Yes
I agree to the official rules (SportingKC.com/BlueKC/rules)
*
Yes