LWVUS 2015-2017 Ruth S. Shur Fellow Nomination Form

Complete the below form to nominate a League leader you know for a two-year term as an LWVUS Ruth S. Shur Fellow for 2015-2017. Self nominations are welcomed and encouraged. To be considered for a position as an LWVUS Ruth S. Shur Fellow, the nominee must currently be an active League member. Please get the nominee's consent before you place their name in nomination. THE DEADLINE TO COMPLETE THIS FORM IS Friday, September 19, 2014.

1. I Nominate:

I would like to nominate the following person for a position as National Coach on the 2015-2017 LWVUS Ruth S. Shur Fellows team: (Self nominations are welcome)

First Name:
Last Name:
Email Address:
Phone Number:
Local League:
State:

Is this a self-nomination?

2. Background Information and Experience

What League leadership position(s) has the nominee held in the past? (Please check all that apply.)

Local League President
Local League Board member
State League President
State League Board member
LWVUS Board member
State Coach
Ruth S. Shur Fellow/ National Coach
Others (e.g. Study Committee, etc.) Please enter an 'other' value for this selection.

Please explain why the nominee would make a good coach and mentor to state League teams. (Coaches act as cheerleaders, accountability coaches, mentors and communicators with up to two state coaching teams.)

Please explain what background experience the nominee has that prepares her or him for a role in coaching (include experiences outside the LWV too if you know them).

3. Special Strengths and Qualities

Please check the top 4 qualities that you consider to be the nominee's special strengths from the list below:

On a scale of 1 to 5, with 1 being the lowest and 5 being the highest, please honestly rate the nominee on each of the following traits.

Space Cell	1	2	3	4	5
Supportive
Patient
Responsive
Flexible
Enthusiastic
Strong Communication Skills
Strong Listening Skills

What is the nominee's greatest weakness?

What is the nominee's greatest strength?

Why would this person be an asset as a coach to state coaching teams? Add comments supporting this nomination, including any unique cultural perspectives (geographic, age, gender, race, and ethnicity) and/or exceptional leadership skills this nominee could bring to the LWVUS Ruth S. Shur Fellows National Coaching Team.

4. Nominator's Contact Information

If you are nominating SOMEONE ELSE for a position, please complete this section by providing your contact information below. You do not need to complete section 5 of the nomination form. If you are nominating YOURSELF for a position, please skip section 4 and complete section 5 of the nomination form.

The Nominator's Information

First Name:
Last Name:
Local League:
State:
Email Address:
Phone Number:

5. Questions for the Nominee

If you are nominating YOURSELF for a position, please complete this section. If you are nominating SOMEONE ELSE for a position, you do not need to complete section 5 or 6 of the nomination form. Please review your work and click "Submit" once you have completed the form.

Please describe one specific situation or incident (from your League or professional experience) in which you coached or mentored another individual and helped them solve a problem for themselves.

Please describe one specific situation or incident (from your League or professional experience) in which you used "outside the box" thinking to solve a problem.

6. Information about References

If you are nominating YOURSELF for a position, please complete this section by providing your references below. Please note that 2 of your 3 references should be League references. Your third reference may be an individual from your professional or personal life. Please notify your references that you are putting them on this form and that they will be contacted by LWVUS.

If you are nominating SOMEONE ELSE for a position, you do not need to complete section 6 of the nomination form. Please review your work and click "Submit" once you have completed the form.

Please provide the following information for your first reference:

Name:
Local League:
State:
Email Address:
Phone Number:
How do you know this individual?:

Please provide the following information for your second reference:

Name:
Local League:
State:
Email Address:
Phone Number:
How do you know this individual?:

Please provide the following information for your third reference:

Name:
Local League (if applicable):
State:
Email Address:
Phone Number:
How do you know this individual?:

7. Submit Your Nomination

Please review your work and click "Submit" once you are finished completing the form.