2024-2025 Nomination Form: White-Riley-Peterson Policy Fellowship

Nominations are due by May 15, 2024 at 11:59 pm

Contact Information for Nominator
Name Name First Last
Title
Company/Organization Name
Email Address
Work Phone Work Phone - ### - ### ####
Mobile Phone Mobile Phone - ### - ### ####
Contact Information for Nominee
Nominee's Name Nominee's Name First Last
Nominee's Title
Nominee's Company/Organization
Nominee's Address Nominee's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Nominee's Email
Nominee's Phone Nominee's Phone - ### - ### ####
Questions about the Nominee

Please answer the following questions and limit to 250 words or less.
Why do you believe this candidate should be nominated for the White-Riley-Peterson Policy Fellowship? Please provide examples of the nominee's potential for developing the skills necessary to effectively advocate for increased state and federal support for expanded learning opportunities.
(one-two paragraphs)
Maximum of 250 words allowed. Currently Entered: 0 words.
Describe this individual's relationship to the Statewide Afterschool Network, and this individual's sphere of influence. Would this individual have the support of the Network lead? How would this Fellow's work support your Mott work plan?
(one-two paragraphs)
Maximum of 250 words allowed. Currently Entered: 0 words.
Will the state Network be able to support the nominee’s participation in and travel to the Spring 2025 50 State Network National Conference?

Will the state Network be able to support the nominee’s participation in and travel to the Spring 2025 50 State Network National Conference? Yes No Unsure
Other comments you wish to include about the nominee:

2024-2025 Nomination Form: White-Riley-Peterson Policy Fellowship

2024-2025 Nomination Form: White-Riley-Peterson Policy Fellowship

Contact Information for Nominator

Contact Information for Nominee

Questions about the Nominee