EmailMe Form - 2022 Summer LEA Nomination Form (Doctoral)

PLEASE NOTE

Students must apply for this award (self-nominate). One (1) Walden faculty or staff member will need to complete the Recommendation Form on your behalf. The link to the form is listed at the bottom of this application.

Name of Student Applying for the Award *

First Last

Walden Student Email Address *

Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Please select your College *

Degree and Program *

Involvement in Student Organizations at Walden (List any Walden Student Organizations that you are involved with. Include any leadership positions held, past or present). *

Current or past community involvement and/or other organization affiliations, the positions held and accomplishments within the last five years (2017 – present). List non-Walden related activities. *

List current or past professional (paid) leadership roles within the last five years (2017 – present). List and describe professional leadership roles from a paid occupation. For leadership role(s), include duration and number of people you managed, supervised, or led. *

Personal Essay

Explain in detail why you are applying for this award:

1. Why are you the best candidate for this award? (250 words or less)

2. How have you demonstrated excellence in leadership at Walden? How has this contributed to positive social change within your community or organization? (500 words or less) *

One (1) Recommendation Form from a Walden Faculty/Staff member is required. Please reach out to one Walden Faculty or Staff member requesting they complete the following form on your behalf to be considered for the Leadership Excellence Award. Only one letter may be submitted on your behalf.

Copy the link below and send to the faculty or staff member that will be submitting a recommendation on your behalf. All recommendations must be received by Friday, April 1, 2022.

https://forms.office.com/r/Pc8B1PpSgU

Note: This form may not be visible to you, but the link will be visible to Walden Faculty/Staff members.

Name of Walden Faculty/Staff Providing Recommendation *

Please enter in the first and last name of the faculty or staff member that will complete the Recommendation Form on your behalf.

Walden Faculty/Staff Email *

Please enter in the email address of the faculty or staff member that will complete the Recommendation Form on your behalf.

Professional Headshot

Please provide a professional headshot photo to be used if you are selected as an award winner.

Date Time

MM / DD / YYYY