2018 ‘Follow the Leader’ Honoree Nomination Form
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Nomination Deadline: January 10, 2018
On Wednesday, March 21, 2018 LEADERSHIP MOHAWK VALLEY will honor outstanding community leaders at the 16th Follow the Leader dinner. Nominees must be a graduate of Leadership Mohawk Valley, and have demonstrated excellence and leadership in the workplace and the community.
Leadership Mohawk Valley’s selection committee is responsible for evaluating and selecting the award recipients. Selections are based on the information provided on this nomination form, and additional documentation will not be considered. So that we may gain a full 360º view of the nominee, we encourage all individuals completing nominations to engage the nominee as well as others close to them professionally and within the community, so that you paint the committee a full picture of the nominee’s achievements.
Please complete this “fill in” form with all information requested for each section.
Candidate information / LMV Graduation Year:Name: / Company: / Job Title:
Home Address: / Home City: / State: / Zip:
Home Telephone: / Home E-Mail Address: / Cellular Telephone:
Work Address: / Work City: / State: / Zip:
Work Telephone: / Work E-Mail Address: / Work Fax:
nominator information
Name: / Company: / Job Title:
Home Address: / Home City: / State: / Zip:
Home Telephone: / Home E-Mail Address: / Cellular Telephone:
Work Address: / Work City: / State: / Zip:
Work Telephone: / Work E-Mail Address: / Work Fax:
Nominator’s preferred form of communication (if needed): Work phone Home phone Other:
In order for this candidate to be considered, entries must be submitted on this form only. No other documentation will be considered. Please type complete information in each section.
A. How does this leader personify lmv’s mission of commitment "to the growth and development of individuals as effective leaders to the benefit of self, organization and community"?
B. What personal qualities/traits distinguish this individual as a leader in the workplace & What is their impact upon their company/organization?
C. List the leader’s community involvement, including volunteer and board roles.
D. What additional personal qualities/traits distinguish this individual as a leader in the community & What is their impact upon the community?
E. Add your personal supporting statements about how this nominee has been a leader and made an impact upon you or others.
all nominations must be received no later than WEDnesday, january 10, 2017. Please email, fax, or mail to:
Leadership Mohawk Valley · 1101 Sherman Drive #AB154E · Utica NY 13501
P: 315.792-5321 · F: 315.792.5682 · W: www.leadershipmohawkvalley.net · E: