- Nominee's Name
- Nominee's Expected Graduation Year
- Nominee's Major/Concentration
- Nominee's Email
- Link to Nominee's LinkedIn Account (if applicable)
- Link to Nominee's Personal Webpage (if applicable)
- Link to Nominee's Twitter Handle (if applicable)
Optional Demographic Information from Nominee
- How does nominee describe their gender identity? Woman/Man/Gender Non-Conforming/Gender-Queer/Intersex/Trans Woman/Trans Man/Other (OPTIONAL)
- What gender pronouns does the nominee use? She, Her, Hers/They, Them, Theirs/He, Him, His/Ze, Hir, Hirs/I don't use gender pronouns (OPTIONAL)
- How does the nominee describe their racial identity? American Indian, Alaska Native, or Native Hawaiian/Asian, Asian America, or Pacific Islander/Black or African American/Hispanic, Latino(a), or Latin(x)/Middle Eastern/Multiracial/White or Caucasian/Other (OPTIONAL)
- Does the nominee identify as a first-generation college student? Yes/No/Prefer not to answer (OPTIONAL)
- Are there other dimensions of the nominee's identity that they wish to mention (i.e.: religious or spiritual identity; socioeconomic status; sexual orientation; etc.)?
Contact Information for Person Submitting Nomination Form
- Nominator Name
- Nominator Title
- Nominator Email
Newman Civic Fellow Mentor Information
As part of the Newman Civic Fellowship all fellows identify a local mentor who serves as a resource for the the fellow during the experience. In nominating a student for the Newman Civic Fellowship, an institution commits to connecting the fellow with a local mentor. To review the criteria and expectations for mentors, please visit the Newman Civic Fellowship FAQ page. The mentors do not have to be identified by the time of nomination. If a mentor has already been identified, please provide that information below.
- Mentor Name
- Mentor's Relationship to Nominee
- Mentor has agreed to serve as a mentor for the duration of the 2017-2018 academic year? Yes/No
Letter of Nomination
This letter should include information about the nominee's approach(es) to addressing the root causes of social issues. These may include, for example, involvement in public policy reform, community organizing, community-based research, social entrepreneurism, or other efforts to build the capacity of community-based organizations. Additionally, please let us know why you believe this person has the motivation and potential to develop innovative and collaborative approaches to addressing public problems and to contribute to a network of similarly committed students. (Limit 1,000 words)
Newman Civic Fellow Leadership Profile
In the space below, please provide a brief (200 word max) abstract summarizing your recommendation. Please include information central to the recommendation including the nominee's approach to addressing the root causes of social issues and about the nominee's potential for developing innovative and collaborative strategies for addressing public problems.
Newman Civic Fellow Personal Statement
In the space below, please provide a brief (200 word max) statement from the nominated student about their work. The student should include information central to the recommendation including their approach to addressing the root causes of social issues and their potential for developing innovative and collaborative strategies for addressing public problems.