Luoma Leadership Academy
2017-2018 Nomination Form
Instructions
· Use this form to respond to the following questions. Total length should be no more than 3 pages.
· Return the completed form to
· Nominations are due on Friday, January 20, 2017
Name:
Title:
Institution (College/University/System Office):
E-mail:
Are you the supervisor of the nominee? Yes No
Nominee
Name:
Title:
Institution (College/University/System Office):
E-mail:
Background information
1. Nominations are evaluated on the following criteria. Please provide specific examples of how the nominee has demonstrated abilities in one or more of these areas.
· Takes initiative
· Demonstrates leadership among peers
· Works collaboratively and builds effective teams
· Finds creative solutions to challenging problems
· Demonstrates decision making
Type response here:
2. How might this individual benefit from participation in the Luoma Leadership Academy?
Type response here:
3. How might the institution and Minnesota State benefit from this individual’s participation?
Type response here:
Sponsored by Minnesota State, Talent Management, Human Resources Division
For more information visit the Luoma Leadership Academy website