Philadelphia Department of Human Services: Child Welfare Leadership Academy Nomination Form

Leadership Academy

Nomination Form (Please discuss with your Nominee prior to completing the form)
Nominee's Information (Supervisor to complete)
Leadership Academy Tier of Interest (select only 1 per Nominee). Sessions will be Hybrid Schedule
Nominee's Name

First NameLast Name
Job Title
Agency
Division
Section
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Date nomination discussed with nominee

MonthDayYear
Date
Nominee voluntarily agrees to participate in the program?
Nominator's Information (Supervisor's information)
Nominator's Name

First NameLast Name
Job Title
Email
example@example.com
Phone Number
Format: (000) 000-0000.
In what capacity have you worked with the nominee?
Based on the program selection criteria and your experience with the nominee, what makes this person a strong candidate for the Leadership Academy?
Please list two ways you will support this candidate throughout their Leadership and Professional Development Journey?
Program Contacts

DHSU.Collaboration@Phila.gov

Lisamarie Rotchford, LMSW

Social Work Supervisor

DHS University

Phone #: (267) 934-1962

Email: lisamarie.rotchford@phila.gov

Shirrell Feaster, MSS

Human Services Program Administrator

DHS University

Phone # : (215) 796-3379

Email: Shirrell.Feaster@phila.gov

For more information about the

Philadelphia Leadership Academy

Please visit our site at: https://www.dhsuniversity.net/Leadership_Academy/index.html
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