Chiefs for Change

Name of nominee *

Title *

School/Organization/Company *

Email *

Phone number

Street address

ZIP code

City

State

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Has the nominee expressed a desire to be a state or district chief?

Yes

No

In your opinion, how many career steps away is this person from a chief role?

1-2

3-4

5 or more

How long have you known the nominee and in what capacity?

Name three reasons why you think this person would make a strong chief.

Reason 1:

Reason 2:

Reason 3:

What supports do you think this person would need in order to become a strong chief?

If you are nominating other individuals for the Future Chiefs program, is this nominee your first choice?

Yes

No

Your name *

Title *

School/Organization/Company *

Email *

How did you learn about the Future Chiefs program? *

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