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“The Harriet Tubman
             Leadership Award”




                           2013 Nomination Form


    Name of the Person
      being Nominated
                  Title

Organization/Affiliation

         Street Address

                    City                    State:            ZIP:

                   Phone

                  Mobile

         Email Address


Date: Nominated:

Provide reason(s) for Nomination (see selection guidelines)


I. Enhancement:
II. Effectiveness:




III. Impact:




IV. Uniqueness:
V. Longevity:




VI. Service:




VII. Commitment:
Please attach supportive information with nomination, if more space is needed.
              Also please attach any pictures of the nominee if you have one.
                             Thank you for your nomination!
      Please email all nomination information to multiculturalcommunityproject@gmail.com

Name of the Nominator

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2013 nomination form Harriet Tubman Award For Outstanding leadership

  • 1. “The Harriet Tubman Leadership Award” 2013 Nomination Form Name of the Person being Nominated Title Organization/Affiliation Street Address City State: ZIP: Phone Mobile Email Address Date: Nominated: Provide reason(s) for Nomination (see selection guidelines) I. Enhancement:
  • 4. Please attach supportive information with nomination, if more space is needed. Also please attach any pictures of the nominee if you have one. Thank you for your nomination! Please email all nomination information to multiculturalcommunityproject@gmail.com Name of the Nominator