NOMINEE INFORMATION

BEFORE YOU START, MAKE SURE YOU HAVE 1) INFORMATION ON THE NOMINEE'S ACCOMPLISHMENTS 2) NAMES AND ADDRESSES OF THE NOMINATORS AND REFERENCES FOR THE NOMINEE 3) REFERENCE LETTERS

Name

First Last

OR Name of the Organization

First

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Email

Contact Person: (For Organizations)

First

Accomplishments: Briefly describe five major achievements that the nominee has successfully attained

Accomplishment 1:(Required)

Accomplishment 2:(Required)

Accomplishment 3:(Required)

Accomplishment 4:(Required)

Accomplishment 5:(Required)

Composition:(Required)

Background about the nominee, of no more than a total of 250 words, typewritten, must be included with this nomination form. It should include: brief biographical data, organizational memberships, special recognition received by the nominee in the past a description of the nominee’s accomplishments that validates their nomination for a YouthLeadership Award.

NOMINATOR INFORMATION

Two individuals are required to advance a nomination for a Leadership Award. Two references concerning the nominee are also required by the appropriate Jury Panel. Names of two nominators are required to advance a nomination. Nominators must be members of a UCC member organization in good standing.

Nominator 1:

First Last Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Email

I hereby declare the information contained in this Nomination Application to be true to the best of my knowledge.(Required)

Yes

Nominator 2:

First Last Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Email

I hereby declare the information contained in this Nomination Application to be true to the best of my knowledge.(Required)

Yes

Nominating Organization – must be a UCC member organization in good standing.

Organizations nominating individuals to be considered for a Leadership Award require two signing officers (ex: president, secretary, treasurer) to advance the nomination for consideration. In addition, an excerpt from the minutes of the organization’s meeting of the Board of Directors approving the nomination, MUST be attached to the nomination form. Forms, which do not have this information, will not be considered by the Jury Panel.

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Email

Name

First Last Name Position

Name

First Last Name Position

Attached is a copy of the excerpt from the Minutes of the meeting of the Board of Directors at which the nomination was approved.

Max. file size: 256 MB.

References: Names of two references are required by the Jury Panel. References must be able to verify the accomplishments of the nominee

Referee 1:

First Last

Phone

Email

A letter of support may be attached

Max. file size: 256 MB.

Referee 2:

First Last

Phone

Email

A letter of support may be attached

Max. file size: 256 MB.

Forms, which do not have this information will be considered incomplete and will not be forwarded to the Jury Panel.

Would you like a copy of this form?

YES

NO

If yes, please enter your email

UCC Youth Leadership Nomination

YOUTH LEADERSHIP AWARD NOMINATION FORM

NOMINEE INFORMATION

Accomplishments: Briefly describe five major achievements that the nominee has successfully attained

NOMINATOR INFORMATION

References: Names of two references are required by the Jury Panel. References must be able to verify the accomplishments of the nominee

Forms, which do not have this information will be considered incomplete and will not be forwarded to the Jury Panel.

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