Refugee Congress Delegate Nomination Form
Form to nominate candidates for empty state seats
Name and State of Nominator:
Nominator Contact Information (phone and email):
Name and State of Nominee:
Nominee Contact Information: Mailing Address, Phone/Cell, and Email
Nominee Gender/Gender Identity and Year of Birth
Nominee Country of Origin and Year of Arrival to US:
Please check if Nominee is:
Special Immigrant Visa (SIV) holder
For Nominators, please briefly describe how you know the Nominee and why you believe the Nominee will be an effective Delegate to the Refugee Congress, including a brief description of their community service, leadership, and advocacy experience.
Please upload here the Nominee's Personal Statement here.
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