Pacific Club IMPACT® Foundation

2024 Lott IMPACT® Trophy
Nominee Evaluation Form

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Nominee:
Student in Good Academic Standing for the 2024 School Year

Recommendation & Understanding

The student listed above has demonstrated a strong commitment to his community and has exhibited superior performance on and off the football field. This student is deserving of consideration for The 2024 Lott IMPACT® Trophy. I have read the IMPACT Statement and understand that The Pacific Club IMPACT® Foundation will equally weigh character with performance.

The Athletic Department and the university acknowledge that The Pacific Club IMPACT Foundation has the right to use the university logo, student athlete’s name and likeness in consideration for the 2024 Lott IMPACT Trophy ® upon acceptance of this recommendation.

IMPACT Statement

Integrity: as proven by the IMPACT of his courage, honesty, strength of character, moral standing, and respect by his teammates.

Maturity:  as exhibited by the IMPACT of his leadership skills, sense of responsibility, wisdom displayed and the consistency of good judgment.

Performance:  as measured by the IMPACT of his athletic performance, his effect on the team and his ability to influence the game and its outcome.

Academics:  as demonstrated by his achievements in the pursuit of academic goals and the IMPACT made within this environment.

Community:  as evidenced by the IMPACT of his commitment of time and/or resources to the communities in which he lives or has interest – the university, his hometown, and any charitable causes he is or has been involved.

Tenacity:  as established by the IMPACT of his resolve, persistence, drive, determination, and ability to overcome adversity, injury and/or personal trauma in his pursuit of goals.

To Be Reviewed and Signed By Nominee:

Release and Authorization: In accordance with my rights to privacy, I have been advised by The Pacific Club IMPACT Foundation ® that the information provided above and that may be requested is required for consideration for nomination for The Lott IMPACT Trophy ®. I hereby authorize any qualified party bearing this document to obtain information from all personnel, educational institutions, governmental agencies, Department of Justice, Youth Authority, law enforcement agencies or individuals relating to my past activities. The information may include academic records, job performance, attendance, and driving, criminal or civil records. I understand the information released is for consideration of nomination for The 2024 Lott Trophy. I further release The Pacific Club IMPACT Foundation ® and any individual associated with the compilation of such information. The Nominee acknowledges that The Pacific Club IMPACT Foundation ® has the right to use the student athlete’s name and likeness in consideration for the 2024 Lott IMPACT Trophy ® upon acceptance of this nomination.