NLA Nomination Form

Nominator Information

Your Name (required)

Your Email (required)

Your Phone Number

Your Chapter & Initiation Year (required) ex: PA Alpha '01

If your nominee is selected as a potential finalist, would you be able to facilitate an introduction?
YesNo

Nominee Information

Nominee's Name (required)

Nominee's Email (required)

Nominee's Phone Number

Nominee's Chapter & Initiation Year ex: PA Alpha '01

Please provide as much detailed information as possible. If you have links to additional resources, publications or articles those are welcome as well.

In what ways has this member excelled within his profession? Please mention any professional awards or recognition if known. (required)

How has this member lived our motto of “The Great Joy of Serving Others” through community service? Please list non-profit affiliations if known. (required)

Has this member been an active alumnus with any unit of Phi Kappa Psi, either locally or nationally? If so, in what capacity? Please list any Chapter Advisor, House Corporation or National Offices/Positions that have been held. (required)

Has this member been a mentor to any Phi Kappa Psi undergraduate members or alumni? (required)

In what other ways has this member shown stellar leadership traits, either within their professional field, community or Phi Kappa Psi? (required)