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The Peter Jennings Award for Civic Leadership

Nomination Form

Note: You may want to draft your essay components in a separate document, and then paste them into the fields below, in case you encounter technical difficulties, such as a dropped Internet connection.

Nominator

Full Name: * *

Street Address: *

Address continued:

City: * State: * Zip: *

E-mail: *

Phone: *

Nominee

Full Name: * *

Street Address: *

Address continued:

City: * State: * Zip: *

E-mail: *

Phone: *

In what capacity and for how long have you known the candidate? *

Statement of Support

Please write a statement in support of your candidate (250-500 words). Your statement may include an inspiring story of your nominee's work. You may also want to address one or more of the following questions: Why do you believe the nominee is an outstanding civic leader? What is this nominee’s impact on the people or communities he/she serves? What leadership qualities does this person possess, and how has he/she demonstrated these? While we welcome additional background or context, please focus on the candidate’s efforts and impact over the past year as this is the basis of the award.*

General Questions

Max. 350 words each

Please describe in-depth the goal, trajectory, scope, and impact of the candidate's work. If possible, give specific information or data regarding the results and breadth of influence of the person's work and why this year, in particular, has been a breakthrough year. Feel free to use detailed bullet points if necessary. Maximum 350 words.*

In what ways do you believe the candidate exemplifies Teach For America's core values (relentless pursuit of results, sense of possibility, disciplined thought, respect and humility, and integrity)? Please give examples. Maximum 350 words.*

What is the biggest challenge the candidate has overcome in pursuit of his/her goals? Maximum 350 words.*

Please list the top five most compelling statistics or data that support this person's candidacy for the Peter Jennings Award for Civic Leadership. Please feel free to cite reports or sources. Maximum 350 words.*