Nomination Form

Nominee Information

Please indicate the category for your nominee

Leader
Legend

Nominee Name

First

Last

Agency or Affiliation

Title

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

What leadership positions does the nominee currently hold (or has held) in the child care and early education community? Describe accomplishments, programs, and activities, and please indicate dates wherever possible

Has the nominee made or promoted connections among individuals, agencies, organizations and government bodies on behalf of children and families? If so, how?

List efforts by the nominee to support, strengthen and enhance child care and early education programs and services.

Provide a few examples of how the nominee’s work has influenced the child care and early education community at large (within Essex County).

In what ways has the nominee exhibited the characteristics of leadership, vision, cooperation, and commitment? List efforts by the nominee to support, strengthen and enhance child care and early education programs and services.

Please provide at least 2 resources to support your nomination. Please include examples of the nominees leadership in early care and education.

Cover page with resume and contact information and any other supporting documentation. Please upload a photo of your nominee.

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

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Nomination Form

Nominee Information

Please tell us about yourself! We inform all of our Leaders & Legends who took the time to identify their hard work and dedication.

Programs for Parents

570 Broad Street, 8th Floor
Newark, New Jersey 07102
973.297.1114

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