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Nomination for Learning for Life Leadership Award Youth Adult (Please check type of award) Post or Group Number Program Tenure (in years) Name of Organization Nominee Information: Name (Student) School/Grade or (Adult) Title/Company Address City Home Phone () State Zip Day Phone () Nominee’s Personal Record (attach additional sheets if needed): Current Organizations (with which the nominee is now active and involved): Past Organizations (with which the nominee was active and involved): Leadership Positions (List all positions that the nominee has ever held and indicate the current positions with an asterisk.) Recognitions (List important achievements, awards, or recognitions received by the nominee the organizations that presented them and the year that they were received.) Statement (Tell in 100 words or fewer how the nominee has demonstrated exceptional dedication and outstanding leadership to the youth participants in either Exploring or Learning for Life programs.) Leadership Award Nomination Form should be sent to the local council..