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