Honorary Co-Captain Program
ExxonMobil and the Dallas Mavericks are looking for middle and high school students who
have a love for science, technology, engineering and/or mathematics (STEM). To applaud
and encourage these bright students to continue their pursuit of excellence in STEM studies,
ExxonMobil wants to recognize these future leaders at a Dallas Mavericks home game as an
ExxonMobil Honorary Co-Captain!
As an ExxonMobil Honorary Co-Captain, selected students will receive two (2) tickets to
a Mavs home game, the opportunity to enjoy pre-game shoot around, sit on the bench
during team introductions and meet the Mavericks team captain at half court. One (1)
ExxonMobil Honorary Co-Captain will be selected for each Mavs home game!
To nominate a student, fill out this form and submit it before Friday, February 26, 2016.
Students must be nominated by a counselor, principal, or teacher. There is no limit to the
number of students per class or school that can be nominated.
Please include any supporting documentation or information to support your nomination.
Name of Student:_________________________
Grade:________ Gender:
M
F
T-shirt Size: S
M
L
XL
2XL
Favorite STEM Field: S
T
E
M
GPA:______
Favorite Mavericks Player:____________________
How does this student express their enthusiasm for the STEM fields of study?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Your Name:______________________________
Counselor
Principal
Teacher
Phone:_______________________
Email Address:________________________________________
School Name:____________________________
School District:____________________________
School Address:______________________
City:_______________ State:______ Zipcode:_______
Parent/Guardian Name:_____________________________________
Parent/Guardian Signature______________________________ *Parent/Guardian signature is mandatory
Parent/Guardian Phone:______________________
Parent/Guardian Email Address:_______________________________
Please return completed nominaton form to:
ExxonMobil Honorary Co-Captain
Dallas Mavericks
2909 Taylor Street
Dallas, TX 75226
OR via fax to (214) 752-3860