Nominate A Colleague

Nominations Are Now Being Accepted

If you know of someone who may benefit from, contribute to, and be interested in experiencing Leadership West Virginia, please submit his/her name below. Program information and an application will be forwarded to each nominee.

I nominate the following person for the next class of Leadership West Virginia.

Nominee First Name

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Nominee Last Name

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Nominee Title

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Nominee Company

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Nominee Email

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City

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Zipcode

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Your Contact information:

Your First Name

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Your Last Name

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Your Phone Number

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Your E-mail Address

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Submit Nominee

Candidates for the Leadership West Virginia program must complete an application in its entirety in order to be considered.

Once you have been nominated, you will be sent to this form to complete your Nomination registration. Please start by entering your name, email, and password in order for you to save or change your application as you proceed. You may view a sample application by CLICKING HERE. After the below form has been completed, you will automatically be redirected to the Class Application form.

Username

* Username

Username can not be left blank.

Please enter valid data.

This username is already registered, please choose another one.

This username is invalid. Please enter a valid username.

First Name

* First Name

First Name can not be left blank.

Please enter valid data.

This first name is invalid. Please enter a valid first name.

Last Name

* Last Name

Last Name can not be left blank.

Please enter valid data.

This last name is invalid. Please enter a valid last name.

Preferred Display Name

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Email Address

* Email Address

Email Address can not be left blank.

Please enter valid email address.

This email is already registered, please choose another one.

Phone

Text field can not be left blank.

Please enter valid data.

Class Year

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Please enter valid data.

Password

* Password

Password can not be left blank.

Please enter valid data.

Please enter at least 6 characters.

Strength: Very Weak

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