Peter Jennings Award Nomination Form

Nominator

Name *

Title/Employer

Address

E-mail *

Phone Number

Nominee

Name *

Title/Employer *

Address *

E-mail *

Phone Number

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

Statement of Support (500 word max)

Please write a statement in support of your candidate. You may wish to consider the following questions: In what ways have your candidate’s efforts made a transformational impact within the community she/he is serving? What leadership qualities does the candidate possess and in what ways has she/he demonstrated these over the course of the past year. Please feel free to include an inspiring story of your nominee’s work.While we welcome any additional background or context, please be sure to focus primarily on the candidate’s efforts and impact in the last year.

Please describe in-depth the goal, trajectory, scope, and outcome of the candidate's work. If possible, provide 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.

In what ways do you believe the candidate exemplifies Teach For America's core values (transformational change, leadership, team, diversity, and respect and humility)? Please give examples.

What is the biggest challenge the candidate has overcome in pursuit of his/her goals?

Please list the top five most compelling results, statistics, or data that support this person's candidacy for the Peter Jennings Award for Civic Leadership. Feel free to cite reports or sources.