*1.1. Name of Employee(Required.)

*2.Nominated By & Contact Information(Required.)

Name

Phone Number

Email Address

3.Employee’s Immediate Supervisor

*4.Describe how this employee has demonstrated leadership excellence in their area of competency during the preceding year.(Required.)

5.Describe how this employee has exemplified our Mission, Vision, Core Purpose and Core Values.

6.Describe how the employee has fostered a congenial and team-focused environment.