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ALF Nomination Form for
Fellows Program

PLEASE NOTE:

If you discuss this nomination with the nominee, please make sure they understand there is no guarantee that they will be selected.  With over 300 nominees, less than 10% will receive an invitation to be one of the 24-27 participants in the program.  Nominations are kept on file for three years.

Questions marked with an asterisk (*) are mandatory.

 

* Your name : 
 
* Name of nominee : 
* Title : 
* Company/organization : 
Address : 
Telephone : 
Email : 
 
Have you spoken with this nominee about the ALF program and tuition costs ($12,500, some scholarship assistance is available) and, if so, do you feel confident the nominee would likely accept an invitation if offered?
 
* How is this person a proven leader committed to the public good, display personal integrity, and work collaboratively? What skills and/or passions would this person bring to the ALF network?
 
* Diversity : 
 African American  American Indian
 Asian/Pacific Islander  Caucasian
 Latino/a  Middle Eastern
 Gay/Lesbian/Bisexual/Transgendered (GLBT)  Other
 
* Gender : 
 Male  Female
 
* Professional Field (choose all that apply) : 
 Agri-Business  Arts
 Association  Community Activist or Representative
 Corporate  Education
 Elected Official  Environment
 Faith  Government
 Health  Labor
 Public Safety  Law/Professions
 Media  Nonprofit
 Philanthropy  Small Business
 
* County where nominee does majority of community work : 
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