USTA Mid-Atlantic Adult Champions for Change Honor Roll Nomination Form

To be eligible for the Champions for Change Honor Roll the nominee must be 19 years or older and connected to tennis as a player, provider/coach, or parent. Nominations must be made by a non-relative adult. To nominate a player under the age of 19 please click here.

I hereby nominate the following individual for the USTA Mid-Atlantic Adult Champions for Change Honor Roll*

First Name

Last Name

Enter the Nominee's Email Address (optional)

Enter the Nominee's State Of Residence (optional)

Category:*

Sportsmanship Community Service

Other:

Please select where the event took place: *

League Match League Championship Tennis Tournament Attending a Tennis Event Off Court or in the Community Tennis Practice

Other:

Please select your role as the nominator out of the following categories: “I am a…”*

Player Spectator USTA Certified Official Coach Provider

Other:

Briefly describe the event or reason for nomination*

Your contact information*

First Name

Last Name

Your email address*

Date*