Leadership Award Nomination Nomination Form Deadline: Friday, October 6 Please select which award you are submitting a nomination for: The University of Houston Hobby School of Public Affairs Leadership Award honors its Hobby Fellows-Austin, Leland Fellows-Washington, Harris Fellows and Civic Houston Intern Alumni who Are distinguished in their profession and poised to accomplish more Mentor others to help advance future leaders Serve as a model of excellence in civic engagement Committed to bettering the lives of others through public service The University of Houston Hobby School of Public Affairs Leadership Award honors its Certified Public Manager Program Alumni who Are distinguished in their profession and poised to accomplish more Demonstrate strong leadership skills within their organization Exemplify the Certified Public Manager Program’s professional standards including the use of best practices and management ethics Committed to bettering the lives of others through public service Self-nominations are acceptable. First Name: Last name: Title: Department: Address: City: State: Zip: Email: Approximate number of Years in Position Other Positions Previously Held</p> <p>Other Relevant Experience<br/> <textarea cols="50" name="Additional" row="10" type="text"/></p> <p>Please Write No more than 600 words describing characteristics and accomplishments of the nominee<br/> <textarea cols="50" name="Description" placeholder="Please be sure to emphasize what distinguishes this person's impact in governemnt from that of his or her peers. You may inlcude an anecdote that provides perspective on the nominee's impact, motivation, management style, or any other relevant qualities." rows="20" type="text"/></p> <p>Additional Comments<br/> <textarea cols="50" name="Additional" row="10" type="text"/></p> <table border="0"> <tbody> <tr> <td> <p><strong>Reference#1</strong></p> </td> </tr> <tr> <td>Name</td> <td><input name="reference1" type="text"/></td> </tr> <tr> <td>Phone</td> <td><input name="phone1" type="text"/></td> </tr> <tr> <td>Email</td> <td><input name="email1" type="text"/></td> </tr> <tr> <td> <p><strong>Reference#2</strong></p> </td> </tr> <tr> <td>Name</td> <td><input name="reference2" type="text"/></td> </tr> <tr> <td>Phone</td> <td><input name="phone2" type="text"/></td> </tr> <tr> <td>Email</td> <td><input name="email2" type="text"/></td> </tr> <tr> <td> <p><strong>Nominator</strong></p> </td> </tr> <tr> <td>First Name</td> <td><input name="nFirst" type="text"/></td> </tr> <tr> <td>Last Name</td> <td><input name="nLast" type="text"/></td> </tr> <tr> <td>Title</td> <td><input name="nTitle" type="text"/></td> </tr> <tr> <td>Department</td> <td><input name="nDepartment" type="text"/></td> </tr> <tr> <td>Phone</td> <td><input name="nPhone" type="text"/></td> </tr> <tr> <td>Email</td> <td><input name="nEmail" type="text"/></td> </tr> <tr> <td>Relationship to Nominee</td> <td><input name="relToNo" type="text"/></td> </tr> </tbody> </table> <p>Please make sure to save a copy of your nomination for your records before clicking the submit button.</p> <p><input type="submit" value="Submit"/></p> </form> <div/> <div/>