FWLF Nomination Form 2026-2027

Nomination Submitted by (Nominator) Please provide full name.

Nominator Phone Number

Nominator Email Address

Are you nominating yourself? Are you nominating yourself? Yes No

Person being Nominated (Nominee) Please provide full name.

Nominee Phone

Nominee Email

Is the Nominee aware of the nomination? Is the Nominee aware of the nomination? Yes No

Nominee Connection to Fullerton Nominee Connection to Fullerton Please select at least one. LIVE/LIVED IN FULLERTON WORK/WORKED IN FULLERTON VOLUNTEER/VOLUNTEERED IN FULLERTON ATTEND/ATTENDED SCHOOL IN FULLERTON OTHER

Other Connection to Fullerton Please describe other connection.

Area(s) where Nominee has shown leadership and/or inspired others Area(s) where Nominee has shown leadership and/or inspired others Please select at least one BUSINESS NON-PROFIT COMMUNITY EDUCATION OTHER

Other Area Please describe the other area(s)

Nominee's Role in one area selected above Name the role of the Nominee in one area identified above.

Where did Nominee fulfill the role identified above? Please provide the name of the business, non-profit, etc.

When did Nominee fulfill the Role? Provide the start year/end year for the role.

Other roles in areas selected above Please list any other roles, including where and when if there are more than one

What actions did Nominee take in the role(s) that led to positive outcomes? Please provide no more than 2 sentences for each role.

What were the resulting positive outcomes from the action(s)? Please provide no more than 2 sentences for each action discussed above.

Is there anything more that was not captured above? Tell us something unique or special, such as being young with potential or having a lifetime of leadership.