Online Nomination Form | Central America Leadership Initiative

We ask your assistance in identifying outstanding individuals for the next class of the Central America Leadership Initiative.

The Central America Leadership Initiative will ONLY be accepting complete Nomination Forms.

The criteria for nominating a Fellow is available in the Nominate a Fellow page.

The deadline for nominations is August 15, 2008.

NOMINEE INFORMATION

Salutation:

Mr.

Mrs.

Ms.

Dr.

Age: *

Name: *

Name: (Last, First, Middle)

Company:

Company/Organization Name

Mailing Address: *

Mailing Address

Phone: *

Phone Number

Fax:

Fax Number

E-Mail: *

E-Mail Address

Date of Birth: *

Date of Birth

List any community service involvement: *

REASON FOR NOMINATION: *

Summarize reasons given in your formal letter.

NOMINATOR INFORMATION

Salutation:

Mr.

Mrs.

Ms.

Dr.

Name: *

Name: (Last, First, Middle)

Company:

Company/Organization Name

Title:

Mailing Address: *

Mailing Address

Phone: *

Phone Number

Fax:

Fax Number

E-Mail: *

Relationship to Nominee: *

DOCUMENTS

Submissions should include the following:

Reasons:

(1) a formal letter stating your reasons for recommending the candidate.

Candidate's résumé:

(2) candidate’s résumé or biographical summary indicating age, address, phone number, educational background, career path, current position, voluntary community service activities.

Candidate’s photo:

(3) candidate’s photo.

Additional information:

(4) any additional information that may help in evaluating his/her qualifications for the program. (Accepted formats for all documents: *.gif, *.jpg, *.png, *.bmp, *.doc, *.pdf, *.ppt, *.rar, *.zip. Max. filesize 800KB)