2024 NLC Institute Nomination Form

1
Your Name* This field is required.
First Name
Last Name
2
Your Email* This field is required.
example@example.com
3
Are you nominating yourself?* This field is required.
Yes
No
4
How are you affiliated with NLC?* This field is required.
Alumni
Current Fellow
National Board Member
Partner
Supporter
No Affiliation
5
Nominee Name* This field is required.
First Name
Last Name
6
Which chapter would this nominee go to?* This field is required.
Arkansas
Atlanta
Augusta
Austin
Boston
Broward
Capital District NY
Chicago
Cleveland
Columbus
Connecticut
Dallas
Denver
Des Moines
Detroit
Houston
Jacksonville
Kentucky
Los Angeles
Louisiana
Maine
Maryland
Miami
Montana
Nashville
New Hampshire
New Jersey
New York City
North Carolina
Oakland
Oklahoma
Omaha
Orange County
Orlando
Pacific Northwest
Palm Beach
Philadelphia
Pittsburgh
Rhode Island
Sacramento
San Antonio
San Diego
San Francisco
St. Louis
Silicon Valley
South Carolina
South TX Frontera
SW Ohio
Tallahassee
Tampa Bay
Tulsa
Twin Cities
Vermont
Virginia
Washington D.C.
Wisconsin
7
Nominee Email Address* This field is required.
example@example.com
8
Nominee Phone Number
Please enter a valid phone number.
9
Why are you nominating this individual? (Optional)
Message will be included in Nomination Notification Email (sent out in May 2024)
Should be Empty: