LeadershipU Nomination Form

Student's First and Last Name

Parent/Guardian First and Last Name

Parent/Guardian Email

Home Mailing Address

City

State

Zip Code

Contact Phone Number

(xxx) xxx-xxxx

Student's GPA

Student's Current High School

Name of Nominator

Nominator's Title and/or Teaching Subject

Nominator's Email Address

Statement of Nomination

On the areas below, how would you rank this student compared to their peers?

Communication Skills

Problem-Solving

Teamwork

Leadership

Service

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