John Massey Leadership Scholars Program
The following will assist in identifying and rating nominations. Please provide full and accurate information.
Nominator Information
Nominator Name
First Name
Last Name
Nominator Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nominator Phone Number
-
Area Code
Phone Number
Nominator Email
example@example.com
Nominator Role - Please check all that apply.
First United Team Members
Community-Based Leader
SE Alumni
SE Faculty
SE Staff
High School Teacher, Counselor or Administrator
Student Nominee Information
Academic Year
Student Name
First Name
Last Name
Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Phone Number
-
Area Code
Phone Number
Student Email
example@example.com
High School
In what capacity and how long have you known the student?
Describe the student's notable qualities, character and attitude about life, including examples of how they have overcome adversity and exhibited leadership.
Please provide a specific example as to how the nominee has demonstrated "grit," integrity and exemplary conduct in his/her personal and/or professional life.
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