Sample Page – Maimonides Jewish Leadership Institute

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Nominator Information

Your Full Name *

Your Email Address *

Your Phone Number

Your Organization / Affiliation

Your Relationship to the Nominee *

Nominee’s Full Name *

Nominee’s Email Address *

Nominee’s Phone Number

Nominee’s Organization / Title / Role

Nominee’s LinkedIn or Professional Profile

Why are you nominating this individual? Are there specific accomplishments, leadership, impact, or community contribution you can share? *

How does the nominee exemplify leadership, impact, or values aligned with MJLI’s mission? *

Nominee’s Strengths or Qualities (select all that apply)

Inspiring leader Community engagement Thoughtful scholar or learner Innovation or influence

Examples or Specific Achievements

Has the nominee been involved in Jewish thought, leadership, or community work? *

Yes No

Briefly describe how the nominee’s background or experience prepares them for this fellowship *

What impact do you expect this fellow will have through participation in MJLI?

Permission to Contact Nominee *

I confirm that I have notified the nominee or have permission to submit this nomination.

Submitter Consent *

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge.