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Candidate Nomination Form

Do you know someone you think would be a great candidate for the CIVIC Leadership Institute? If so, please complete this form, along with any additional information that you think would be valuable for the selection process. A resume or vitae must be submitted along with this form for consideration. Submitted by (Your Name): Name of Nominee: Position/Title: Company/Organization: Work Address: Contact Number: Email Address: City of Residence: Why should this person be a member of an upcoming CIVIC class?

How is this person active in the community?

PLEASE NOTE: Please fax the completed form along with the candidates resume or vitae to (757) 451-6875. Completed recommendation forms may also be sent to: CIVIC Leadership Institute 5200 Hampton Blvd. Norfolk, VA 23508 Email: staff@civicleadershiphr.org

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