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Online Nomination Form

Thank you for nominating. We have allocated space for you to nominate up to 10 of your outstanding students in the 9th, 10th or 11th grade during the 2011/2012 academic year. Please provide the information required below. If you have any questions regarding the nomination process, contact us via our special educator-only e-mail address laweducator@nylf.org.

Educator / Mentor Information

Prefix:*
First Name:*
Last Name:*
E-mail:*
 
(Why is this required?)
Institution (or School Name):*
Preferred Phone:*
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Institution Fax:*
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There are times when NYLF seeks faculty advisors for its programs. Check here if you would be interested in serving.

Educator/Mentor Identification

I have received an invitation to nominate. I am submitting my Nominator ID below.
I am using another educator/mentor's invitation to nominate. I am submitting his/her Nominator ID below.
I did not receive an invitation to nominate and do not have a Nominator ID. (Go directly to "Nominee One " below.)
 

Nominator ID:
-

Nominee One (Required)

First Name:*
Last Name:*
Address 1:*
Address 2:
City:*
State:*
Zip Code:*
Gender:*
Grade in 2011/2012 Academic Year:*

Nominee Two

First Name:
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Address 1:
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Gender:
Grade in 2011/2012 Academic Year:

Nominee Three

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Nominee Four

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Nominee Five

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Nominee Six

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Nominee Seven

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Nominee Eight

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Nominee Nine

First Name:
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Nominee Ten

First Name:
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Address 1:
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Zip Code:
Gender:
Grade in 2011/2012 Academic Year:

Submit Your Nominations

By submitting, I agree that NYLF may contact me by e-mail, fax or phone with any questions about my student nominations.



*Indicates required field.
 

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