Youth Leadership Award Nomination
Submitted Date
/
Month
/
Day
Year
Date Picker Icon
Nominator
(May not be a family member or relative of the Nominee)
1. Full Name
*
1. Full Name
2. Affiliation
*
e.g., School, Business, Organization
3. Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
4. Email
*
example@example.com
5. Relation to Nominee
*
e.g., Teacher, Pastor, Community Partner
Back
Next
Save and continue later
Nominee
6. Full Name
*
6. Full Name
7. Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
8. Email
*
example@example.com
9. Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
10. Supervisor District
*
District 1
District 2
District 3
District 4
District 5
Lookup Supervisorial District
11. School Affiliation
*
11. School Affiliation
12. Nominee's Grade at Time of Nomination
*
Please Select
1
2
3
4
5
6
7
8
9 (Fresh)
10 (Sophomore)
11 (Junior)
12 (Senior)
12. Nominee's Grade at Time of Nomination
13. Description of Achievement
*
Make sure to include specifics, such as dates, special projects were completed or awards were received, description of how the community was positively impacted by the nominee’s work, how this nominee may have overcome special obstacles, quotes from community members about theachievement, values the nominee’s work demonstrates and promotes.
14. Letter of recommendation
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
15a. Other Supporting Documents
*
Browse Files
Drag and drop files here
Choose a file
Please provide recordings of the achievement, etc.
Cancel
of
15b. Other Supporting Links
*
Please provide links to media mentions, web pages about the achievement, etc. If none, write 'N/A'
16. If applicable, please describe any notable obstacles or challenges the nominee overcame in his/her/their leadership journey, otherwise write 'N/A'
*
16. If applicable, please describe any notable obstacles or challenges the nominee overcame in his/her/their leadership journey, otherwise write 'N/A'
17. Please Provide a Photo of the Nominee
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Save and continue later
Submit
Should be Empty: