Natural Leaders Nomination
Spring 2019
Email address *
Nominator (your name) *
Your answer
Nominator title and organization *
Your answer
Nominator day-time phone *
Your answer
Nominator email *
Your answer
I have spoken to my nominee, and they are interested in participating, if selected. *
How did you learn about NLI? (Check all that apply). *
Required
Nominee name (the person you are nominating to NLI) *
Your answer
Nominee's phone number *
Your answer
Nominee's email *
Your answer
How do you know the nominee? *
Your answer
Why are you nominating this person to NLI? What do you think they will gain from participating? What do you think they will offer others in the group? *
Your answer
Please check one of the following: *
Required
For employer-covered registration fees, please provide the name, mailing address, email, and phone for the person who should receive the invoice.
Your answer
Confirmation
You will receive an automatic email receipt with your responses that confirms your nomination has been received. Please check your "junk" folder if you do not see it. (You will NOT receive a confirmation screen after clicking "submit.")
Help support NLI
NLI prioritizes participation by those most under-represented in community leadership (people of color, those with low/moderate-incomes, and immigrants). We depend on small grants and individual support to do so. If you wish to make a donation to NLI to cover some or all of these program costs, you may send a check payable to "CCE-Tompkins," to Natural Leaders Initiative, 615 Willow Ave., Ithaca, NY 14850 or donate online <www.ccetompkins.org/nli>
A copy of your responses will be emailed to the address you provided.
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