GPSA Locations

GPSA Office
P.O. Box 413
Pueblo, CO 81002

GPSA Room
Massari Arena
CSU-Pueblo
Pueblo, CO 81007

Hall of Fame Wall
Thatcher Building (Main Floor)
5th and Main
Pueblo, CO 81003

Top Panel
Thursday, 29 October 2020
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Official GPSA Nomination Form Page 1

Nominee's Information

Does the nominee have a nickname?

Do you know the Nominee's middle name?

What is the Nominee's Address?

Please list the city where the nominee resides

Please list the state the nominee resides.

What is the zip code where the nominee resides.

Invalid Input

Note: Categories are for the purpose of assisting the selection committee.

Please list the phone number of the nominee

What is the nominee's place of birth?

What state was the nominee born?

How long has the nominee lived in Pueblo?

Spouse/Closest Living Relative Information

What is spouse's name or closest living relative.

Nominee's spouse/relative's address?

Please list the phone of spouse or relative

What city does the spouse/relative live in?

What state does the spouse/relative live in?

What is the zip code of spouse/relative?

Nominator's Information

Who is nominating you to the GPSA?

What is the nominator's phone number?

Please input the nominator's email address (correctly) please.

What is the relationship to the nominee?

What is the nominator's address?

What city does the nominator live in?

What state does the nominator live in?

What is the zip code of the nominator?

Invalid Input

If the nominee has a felony conviction, please attach an explanation on a separate sheet of paper and attach to the application.

Name of nominee

has demonstrated high moral character and outstanding citizenship, and the information facts I have given are true and correct. I authorize the GPSA to inquire of any and all persons who I have named in this nomination.

Nominator, please sign here

Date signed by nominator

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