2022 Jefferson County Emerging Leader Award Nomination Form

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Deadline: January 24th, 2022

This is your opportunity to acknowledge an emerging leader in Jefferson County. The Emerging Leader Award is designed to recognize an individual who has displayed excellent leadership in their community, their employment, and in their personal life. This recipient of this award has taken strides to grow and improve in their leadership abilities. Nominees must be involved in the Chamber to qualify.

Judging Criteria:
A panel of judges will independently score each of the nominations based on their written application.

Qualifications:
 Professional Leadership: Individual demonstrates excellence, creativity, and
initiative in their business.
 Personal Leadership: Individual serves as a role model for emerging leaders both
personally and professionally.
 Community Leadership: Individual provides valuable service through community
involvement.
 Individual is a Jefferson County resident.
 Individual has a positive public image favorable to Chamber goals.
 Individual strives toward professional accomplishment.
 Individual is not a current elected political official
 Individual has served the community outside the workplace.
 Individual has given extra effort to encouraging leadership growth in themselves
and others in the community.

Email *

Please provide the following information about the person you are nominating:

Name of Nominee *

Home Address

Work Address

Email & Phone Number *

Please provide the following information about yourself:

Name of Sponsor *

Home Address *

Email & Phone Number *

Relationship to nominee *

Please answer the following questions about the person you are nominating:

Please list examples of how the nominee has demonstrated strong leadership skills in the community, which have made a lasting impact on their organization, community, or personal leadership. *

Please describe why you feel this individual is an Emerging Leader in Jefferson County. *

Please provide a brief background of nominee’s work and volunteer experience in Jefferson County. *

Please provide a brief background of their family history (optional).

Please list any additional information you would like the selection committee to consider.

Please type your name and the date below, as a signature that the above information is accurate to the best of your knowledge.

Name *

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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