Fellowship Nomination Form

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Thank you for your interest in nominating a community leader for the Idea of America Fellowship's Central Nebraska Cohort. Please fill out the following information and we will be in touch with you about your nomination, unless you wish to remain anonymous.

We are currently recruiting to launch a Cohort for Central Nebraska for fall 2025. Dates for the Cohort's gatherings are:

›› September 6, 2025, a half-day, in-person kickoff gathering

›› October 10 and 11, a two-day overnight retreat

›› October 25, a virtual session

›› November 14, 15, and 16, our final gathering – a three-day overnight retreat

The cost of the Fellowship is free. There are no out-of-pocket costs to fellows except their time and willingness to engage. Meals, lodging, and travel reimbursement are provided.

If you or your nominee live in another part of the state or are interested but unavailable for these dates, you're welcome to still fill out the info here. We will be in touch soon about the possibility of being involved in the future.

Nominator's Name *

Nominator's Email *

Nominator's Phone Number *

Fellowship Nominee's Name *

Fellowship Nominee's Email *

Fellowship Nominee's Phone Number *

What is your relation to the nominee? Self-interest or personal nomination is fine. *

Can we share that you nominated the potential fellowship member or would you prefer to remain anonymous? *

Yes

No, I would prefer the nomination remain anonymous

Which of the following best describes the Nominee? *

Current Elected/Appointed Official

Former Elected/Appointed Official

Interested in running for public office (at any level)

Community Leader/Advocate

Not interested in running for office, just interested in the subject material

Other:

Required

Does the nominee have any community building experience? *

Yes, they have served on multiple boards and in other capacities.

Yes, however the experience may be limited or just starting.

No, I am not aware of any community building experience the nominee may possess.

Other:

Which public office does the nominee currently hold, has previously held, or would be seeking to hold if they are considering running for office? Put N/A if does not apply. *

Tell us briefly why you think the nominee should consider elected leadership, if this question is applicable to them. Put N/A if does not apply. *

What do you think the nominee would gain from the fellowship experience? *

Do you or the nominee have any questions or concerns about the Idea of America Fellowship? *

Demographic Info

In the spirit of having a balance of backgrounds and perspectives in the cohort, please answer the following questions. We would appreciate it, but it is not required.

Nominee's ZIP code of residence

Nominee's Age

18-24

25-34

35-44

45-54

55-64

65-74

75+

Clear selection

Nominee's Gender

Nominee's Race

Which political leaning best describes the nominee?

Very Conservative

Conservative

Lean Conservative

Lean liberal

Liberal

Very Liberal

Independent/Moderate

Libertarian

Other:

Clear selection

Submit

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