Nominator Form | Nexus Community Partners

Nominator name *

First

Last

Nominator Title/Position *

Nominator organization (if applicable)

Nominator address (if applicable)

Address Line 1

Address Line 2

City

State

Zip Code

Nominator email *

Applicant name *

First

Last

Priority board, commission, or committee targeted for applicant: *

See packet for more details on positions

Additional board, commission, or committee targeted for applicant:

Relationship of applicant to nominator: *

If other, please explain: *

Please indicate what types of support, if any, your organization or you as a nominator are willing to provide the applicant once they are seated (check all that apply): *

Regularly scheduled check‐ins around policy and project topics.
Work space, computer, or other office equipment support.
Release time (if employee) for work on a board or commission that furthers your organization’s mission.
Policy briefings for nominee and other cohort members, as appropriate.
Other

If other, please explain: *

Upload Nomination Letter *

Click or drag a file to this area to upload.