Scholar Athlete Award Nomination

Scholar Athlete Award Nomination
Please complete the information on all the pages. Click Save to save that page and have the saved form link emailed to you. Directions on how to save and retrieve your saved form are available. After you have completed all pages, you will be able to Submit for consideration.

NOTE: For schools wishing to submit nominees for local recognition, simply email Deb Lepak name(s) of student-athlete(s), one senior male and one senior female.
School Year*
School Name*
Name of Nominating Person*

First NameLast Name
Athletic Director Name*

First NameLast Name
Athletic Director Email*
example@example.com

REQUIREMENTS FOR ELIGIBILITY: To be eligible for nomination, a student must be a second semester senior, must have a cumulative grade point average of at least 3.0 (on a 4.0 scale) for classwork completed in the 9th, 10th, 11th, and first semester of the 12th school years and must have earned at least four varsity letters, through athletic participation, in a sport or sports sanctioned by the WIAA. Each school may nominate only one male and one female student athlete.
Student Information
Student Name*

First NameLast Name
Gender*

MaleFemale
Cell Phone Number*
Please enter a valid phone number.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family Income
Can the nominee attend the Scholar Athlete Awards Banquet on Sunday, May 4, 2025?*

YesNo
Has the nominee had an athletic code violation during their high school career?*

YesNo
Academic Information
Cumulative GPA *
Round to 2 decimal places (rounded to nearest 100th of a point), based on classwork completed in the 9th, 10th, 11th, and first semester of the 12th school year.
Class Rank
Class Size*
SAT Score
ACT Score
Student Essay

In 250 words or less, the student should attach a document to answer to the following question. Note: If the student is not seeking statewide WIAA Scholar Athlete recognition, this is optional. If no essay is received with the nomination, it will be assumed that only school recognition is being sought.
What are the greatest lessons you learned in your high school academic and athletic experiences that will help you later in life?

PDF is required
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Provide any documents you wish to share as an essay or other comments and information

PDF is required
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Co-Curricular Activities

Please list all co-curricular activities in which the student has participated during the student's 9th, 10th, 11th, and 12th grade school years. Please also indicate the number of years the student has participated in the specified organization / activity. In addition, if the student has held any office in this organization / activity, indicate the office held. This information is requested for publicity purposes only. It is not a factor in the selection of the statewide Scholar Athletes.
Co-Curricular Activities
Civic and Community Activities
Please list civic and community activities in which the student has participated. This information is optional and is not used in the judging process.
Achievements / Other Comments and Information Documents

Provide any documents you wish to share regarding achievements or other comments and information
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Should be Empty:

	Sport	Grade	Year	Varsity Letter	Varsity MVP	1st Team All Conf	Conf MVP	Ind Conf Champ	Ind Regional Champ	Ind Sectional Champ	Ind State Champ
1
2
3
4
5
5
6
7
8
9
10
11
12
13
14

	Sport	Grade	Year	Team Conf Champ	Team Regional Champ	Team Sectional Champ	Team State Champ
1
2
3
4
5
5
6
7
8
9
10
11
12
13
14

Scholar Athlete Award Nomination

Student Information

Academic Information

Student Essay

Individual & Team Achievements

Individual Achievements

Team Achievements

Co-Curricular Activities