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LWVUS 2016-2018 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 2016-2018. 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 Sunday, November 15, 2015.

1. I Nominate:

I would like to nominate the following person for a position as National Coach on the 2016-2018 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.)

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).

What leadership experience has the nominee had outside of the League? Please explain the organization this experience was with and what sort of role the nominee had.

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	Supportive: 1	Supportive: 2	Supportive: 3	Supportive: 4	Supportive: 5
Enthusiastic	Enthusiastic: 1	Enthusiastic: 2	Enthusiastic: 3	Enthusiastic: 4	Enthusiastic: 5
Flexible	Flexible: 1	Flexible: 2	Flexible: 3	Flexible: 4	Flexible: 5
Patient	Patient: 1	Patient: 2	Patient: 3	Patient: 4	Patient: 5
Responsive	Responsive: 1	Responsive: 2	Responsive: 3	Responsive: 4	Responsive: 5
Strong Communication Skills	Strong Communication Skills: 1	Strong Communication Skills: 2	Strong Communication Skills: 3	Strong Communication Skills: 4	Strong Communication Skills: 5
Strong Listening Skills	Strong Listening Skills: 1	Strong Listening Skills: 2	Strong Listening Skills: 3	Strong Listening Skills: 4	Strong Listening Skills: 5
Ability to Foster and Create Positive Change	Ability to Foster and Create Positive Change: 1	Ability to Foster and Create Positive Change: 2	Ability to Foster and Create Positive Change: 3	Ability to Foster and Create Positive Change: 4	Ability to Foster and Create Positive Change: 5
Comfort with Technology and the Online Environment	Comfort with Technology and the Online Environment: 1	Comfort with Technology and the Online Environment: 2	Comfort with Technology and the Online Environment: 3	Comfort with Technology and the Online Environment: 4	Comfort with Technology and the Online Environment: 5

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.

Why do you want to be a Ruth S. Shur Fellow? What specifically about being a national coach interests you?

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.