Athlete Lifetime Achievement SOO Registration Number Athlete's Name* First Last Athlete's Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Athlete's Phone Number*Athlete/Parent's Email* Nominator's Name* First Last Nominator's Phone Number*Nominator's Email* Please put a check mark beside as many of the following criteria that apply. Each nominee must meet at least 10 out of the following 15 criteria to be considered. Been involved with Special Olympics for minimum 10 years Exhibits sportsmanship Participated at Provincial/National Games Involved in after school groups or community groups Acts as a mentor for others Well-liked and respected by all Continually improves, enhances personal development Always gives their best Continually improves sports skills Has worked hard to achieve personal goals Shows commitment Always attends practices Always gives 100% effort in practices Exemplifies the true spirit of Special Olympics Shows respect for fellow teammates, coaches and officials Demonstrates the concept of athlete empowerment Please give three (3) reasons why the nominee is deserving of this award.Please complete the following information in support of this nomination.a. Please specifiy how long the athlete has been/was involved in a Special Olympics Program(s)?*b. Please identify the sport(s) the athlete has participated in.*c. List significant contribution/participation.*2. ATHLETIC AND PERSONAL DEVELOPMENTa. How has the athlete demonstrated athletic and personal growth in sport? Please provide specific examples of how the athlete has done their personal best to achieve their athletic goal(s) and improve their athletic skills over the course of their career.3. SPORTSMANSHIPa. How has the athlete exemplified the true spirit of Special Olympics? Please provide specific examples. This may include acts of sportsmanship, leadership and being considerate of fellow athletes, coaches, officials etc.4. ADDITIONAL CONSIDERATIONSPlease list any other significant achievements the nominee has achieved outside of their athletic accomplishments (i.e. International Global Ambassador, Board Member, etc.).Please provide one reference letter. Click on Browse to upload file(s) Drop files here or Select files Max. file size: 512 MB.
