2023-2024 Rising Star Submission Form
Deadline to Submit: May 1, 2023
Rising Star Name
*
First Name
Middle Name
Last Name
Designation(s)
Phonetic Spelling
e.g., Telephone (TEL-uh-fOn)
Title
*
Company
*
Email
*
example@example.com
Professional Headshot
*
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Brief Description
*
What makes them a Rising Star? To be listed on Nicsa's website.
0/300
Rising Star's Ethnic or Racial Identity
Asian or Pacific Islander
Black or African American
Caucasian
Hispanic or Latinx
Native American or Indigenous
Decline to Identify
Other (please specify, if possible)
Which Gender Identity Does the RS Most Closely Identify With?
Female
Male
Transgender Female
Transgender Male
Gender Variant/Non-Conforming
Decline to Identify
Other (please specify, if possible)
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
May we contact you regarding this Rising Star's award? If not, please provide a point of contact below.
*
Yes
No
Point of Contact Name
First Name
Last Name
Point of Contact Email
example@example.com
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