12th Annual CUNY Women's Leadership Conference - Nomination Form

Thank you for nominating a student for the CUNY Women's Leadership Conference. The conference will be held on Friday, October 28, 2016 from 9:00am - 4:00pm at Hunter College. Nominees must be able to commit to participating in the full day conference. Please confirm your nominees interest and availability before submitting the nomination. Only ten (10) students will be selected to attend. Final appointments will be made by President Fritz.

Please use additional forms, if you are nominating more than one student. Please call Debi Kee at 718.8982-3268 if you have questions, or difficulty submitting your nomination.

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* 1. Full name of Student Nominee (first and last name):

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* 2. CUNY Empl ID#:

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* 3. Contact Information for Nominee:

Address:

City/Town:

State:

ZIP:

Preferred Email Address:

Phone Number (cell phone, if known):

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* 4. Is the nominee able to attend the full day conference at Hunter College (if selected)?

Yes

Pending Confirmation from faculty/employer regarding missing class/work

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* 5. Statement about the student and why you are nominating her:

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* 6. Are you interested in participating in the Conference as one of the three faculty/staff members? Final appointments for faculty/staff nominees will be made to President Fritz.

Yes

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* 7. Please provide your contact information:

Name

Title

Campus Mailing Address (Department, Building and Room #)

Email Address

Phone Number

Thank you for your nomination. We will select 10 from among those nominated. We have tried our best in the past to send a diverse selection of women from freshmen to graduate students. Please contact the nominee and let them know that if selected they will get a letter from the President's Office. If they have questions, they can call 718.982.3268.