nylc.org
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Submitted URL: https://service-learning.org/
Effective URL: https://nylc.org/
Submission: On January 24 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://nylc.org/
Submission: On January 24 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 3 forms found in the DOM
POST /
<form method="post" enctype="multipart/form-data" id="gform_1" class="color="red"" action="/" data-formid="1" novalidate="">
<div class="gform-body gform_body">
<div id="gform_fields_1" class="gform_fields top_label form_sublabel_above description_below">
<div id="field_1_4" class="gfield gfield--type-section gsection field_sublabel_above gfield--has-description field_description_below gfield_visibility_hidden" data-js-reload="field_1_4">
<div class="admin-hidden-markup"><i class="gform-icon gform-icon--hidden"></i><span>Hidden</span></div>
<h3 class="gsection_title fusion-responsive-typography-calculated" data-fontsize="24" style="--fontSize: 24; line-height: 1.5; --minFontSize: 24;" data-lineheight="36px">Next Steps: Sync an Email Add-On</h3>
<div class="gsection_description" id="gfield_description_1_4">To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page
(https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.</div>
</div>
<fieldset id="field_1_2" class="gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_2">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_1_2">
<span id="input_1_2_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_2.3" id="input_1_2_3" value="" aria-required="true" autocomplete="given-name">
<label for="input_1_2_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_1_2_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_2.6" id="input_1_2_6" value="" aria-required="true" autocomplete="family-name">
<label for="input_1_2_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</fieldset>
<div id="field_1_9" class="gfield gfield--type-text gfield--width-half .placeholdercolor gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_9"><label
class="gfield_label gform-field-label" for="input_1_9">Organization/Institution<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_9" id="input_1_9" type="text" value="" class="large" placeholder="Organization Name or N/A if not applicable" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_1_1" class="gfield gfield--type-email gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_1"><label
class="gfield_label gform-field-label" for="input_1_1">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_1" id="input_1_1" type="email" value="" class="large" aria-required="true" aria-invalid="false">
</div>
</div>
<div id="field_1_8" class="gfield gfield--type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_8"><label
class="gfield_label gform-field-label" for="input_1_8">Residing State<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select">
<div class="gravity-select-parent"><select name="input_8" id="input_1_8" class="large gfield_select" aria-required="true" aria-invalid="false">
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="DC">DC</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
<option value="Outside the Continental United States">Outside the Continental United States</option>
</select>
<div class="select-arrow" style="height: 38px; width: 38px; line-height: 38px; left: 173.031px;"></div>
</div>
</div>
</div>
<div id="field_1_7" class="gfield gfield--type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_7"><label
class="gfield_label gform-field-label" for="input_1_7">Profession<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select">
<div class="gravity-select-parent"><select name="input_7" id="input_1_7" class="large gfield_select" aria-required="true" aria-invalid="false">
<option value="Afterschool">Afterschool</option>
<option value="Community-Based Organization">Community-Based Organization</option>
<option value="Higher Ed Administrator">Higher Ed Administrator</option>
<option value="Higher Ed Teacher">Higher Ed Teacher</option>
<option value="Higher Ed Student">Higher Ed Student</option>
<option value="K-12 Administrator">K-12 Administrator</option>
<option value="K-12 Teacher">K-12 Teacher</option>
<option value="K-12 Student">K-12 Student</option>
<option value="Other (Foundation, Government, National Service, etc.)">Other (Foundation, Government, National Service, etc.)</option>
</select>
<div class="select-arrow" style="height: 38px; width: 38px; line-height: 38px; left: 173.047px;"></div>
</div>
</div>
</div>
<div id="field_1_10" class="gfield gfield--type-captcha gfield--width-full field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_1_10"><label class="gfield_label gform-field-label"
for="input_1_10">CAPTCHA</label>
<div id="input_1_10" class="ginput_container ginput_recaptcha gform-initialized" data-sitekey="6LenftwlAAAAADCMsZ_uE-HYEDQ7xRrO-Smr9rYc" data-theme="light" data-tabindex="0" data-badge="">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-lk4qpaq5mz7y" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LenftwlAAAAADCMsZ_uE-HYEDQ7xRrO-Smr9rYc&co=aHR0cHM6Ly9ueWxjLm9yZzo0NDM.&hl=en&v=QUpyTKFkX5CIV6EF8TFSWEif&theme=light&size=normal&cb=3s830mjx1sjp"></iframe>
</div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div>
</div>
</div>
<div id="field_submit" class="gfield gfield--type-submit gfield--width-full field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-field-class="gform_editor_submit_container"
data-field-position="inline" data-js-reload="true"><input type="submit" id="gform_submit_button_1" class="gform-button gform-button--white button" value="Join"
onclick="if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} jQuery("#gform_1").trigger("submit",[true]); }">
</div>
<div id="field_1_11" class="gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_1_11"><label
class="gfield_label gform-field-label" for="input_1_11">Name</label>
<div class="ginput_container"><input name="input_11" id="input_1_11" type="text" value="" autocomplete="new-password"></div>
<div class="gfield_description" id="gfield_description_1_11">This field is for validation purposes and should be left unchanged.</div>
</div>
</div>
</div>
<div class="gform_footer top_label">
<input type="hidden" class="gform_hidden" name="is_submit_1" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="1">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_1"
value="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">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_1" id="gform_target_page_number_1" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_1" id="gform_source_page_number_1" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
<p style="display: none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_1" name="ak_js"
value="1706129293683">
<script>
document.getElementById("ak_js_1").setAttribute("value", (new Date()).getTime());
</script>
</p>
</form>POST /#gf_10
<form method="post" enctype="multipart/form-data" id="gform_10" class="color="red"" action="/#gf_10" data-formid="10" novalidate="">
<div id="gf_progressbar_wrapper_10" class="gf_progressbar_wrapper">
<p class="gf_progressbar_title">Step <span class="gf_step_current_page">1</span> of <span class="gf_step_page_count">2</span>
</p>
<div class="gf_progressbar gf_progressbar_blue" aria-hidden="true">
<div class="gf_progressbar_percentage percentbar_blue percentbar_50" style="width:50%;"><span>50%</span></div>
</div>
</div>
<div class="gform-body gform_body">
<div id="gform_page_10_1" class="gform_page " data-js="page-field-id-1">
<div class="gform_page_fields">
<div id="gform_fields_10" class="gform_fields top_label form_sublabel_above description_below">
<div id="field_10_4" class="gfield gfield--type-section gsection field_sublabel_above gfield--has-description field_description_below gfield_visibility_hidden" data-js-reload="field_10_4">
<div class="admin-hidden-markup"><i class="gform-icon gform-icon--hidden"></i><span>Hidden</span></div>
<h3 class="gsection_title fusion-responsive-typography-calculated" data-fontsize="24" style="--fontSize: 24; line-height: 1.15; --minFontSize: 24;" data-lineheight="27.6px">Next Steps: Sync an Email Add-On</h3>
<div class="gsection_description" id="gfield_description_10_4">To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page
(<a href="https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/" rel="nofollow">https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/</a>). Important: Delete this tip before you publish the
form.</div>
</div>
<fieldset id="field_10_2" class="gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_2">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Nominator Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_10_2">
<span id="input_10_2_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_2.3" id="input_10_2_3" value="" aria-required="true" autocomplete="given-name">
<label for="input_10_2_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_10_2_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_2.6" id="input_10_2_6" value="" aria-required="true" autocomplete="family-name">
<label for="input_10_2_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</fieldset>
<div id="field_10_23" class="gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_23"><label
class="gfield_label gform-field-label" for="input_10_23">Title<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_23" id="input_10_23" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_10_24" class="gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_24"><label
class="gfield_label gform-field-label" for="input_10_24">Organization/School<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_24" id="input_10_24" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_10_1" class="gfield gfield--type-email gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_1"><label
class="gfield_label gform-field-label" for="input_10_1">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_1" id="input_10_1" type="email" value="" class="large" aria-required="true" aria-invalid="false">
</div>
</div>
<div id="field_10_26" class="gfield gfield--type-phone gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_26"><label
class="gfield_label gform-field-label" for="input_10_26">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_26" id="input_10_26" type="tel" value="" class="large" aria-required="true" aria-invalid="false"></div>
</div>
<fieldset id="field_10_25" class="gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_25">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row" id="input_10_25">
<span class="ginput_full address_line_1 ginput_address_line_1 gform-grid-col" id="input_10_25_1_container">
<label for="input_10_25_1" id="input_10_25_1_label" class="gform-field-label gform-field-label--type-sub ">Street Address</label>
<input type="text" name="input_25.1" id="input_10_25_1" value="" aria-required="true">
</span><span class="ginput_full address_line_2 ginput_address_line_2 gform-grid-col" id="input_10_25_2_container">
<label for="input_10_25_2" id="input_10_25_2_label" class="gform-field-label gform-field-label--type-sub ">Address Line 2</label>
<input type="text" name="input_25.2" id="input_10_25_2" value="" aria-required="false">
</span><span class="ginput_left address_city ginput_address_city gform-grid-col" id="input_10_25_3_container">
<label for="input_10_25_3" id="input_10_25_3_label" class="gform-field-label gform-field-label--type-sub ">City</label>
<input type="text" name="input_25.3" id="input_10_25_3" value="" aria-required="true">
</span><span class="ginput_right address_state ginput_address_state gform-grid-col" id="input_10_25_4_container">
<label for="input_10_25_4" id="input_10_25_4_label" class="gform-field-label gform-field-label--type-sub ">State / Province / Region</label>
<input type="text" name="input_25.4" id="input_10_25_4" value="" aria-required="true">
</span><span class="ginput_left address_zip ginput_address_zip gform-grid-col" id="input_10_25_5_container">
<label for="input_10_25_5" id="input_10_25_5_label" class="gform-field-label gform-field-label--type-sub ">ZIP / Postal Code</label>
<input type="text" name="input_25.5" id="input_10_25_5" value="" aria-required="true">
</span><span class="ginput_right address_country ginput_address_country gform-grid-col" id="input_10_25_6_container">
<label for="input_10_25_6" id="input_10_25_6_label" class="gform-field-label gform-field-label--type-sub ">Country</label>
<div class="gravity-select-parent"><select name="input_25.6" id="input_10_25_6" aria-required="true">
<option value="" selected="selected"></option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cabo Verde">Cabo Verde</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos Islands">Cocos Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic of the">Congo, Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czechia">Czechia</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Eswatini">Eswatini</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See">Holy See</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Macedonia">North Macedonia</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Réunion">Réunion</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin">Saint Martin</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten">Sint Maarten</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria Arab Republic">Syria Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, the United Republic of">Tanzania, the United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Türkiye">Türkiye</option>
<option value="US Minor Outlying Islands">US Minor Outlying Islands</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="Åland Islands">Åland Islands</option>
</select>
<div class="select-arrow" style="height: 38px; width: 38px; line-height: 38px; left: 272.703px;"></div>
</div>
</span>
<div class="gf_clear gf_clear_complex"></div>
</div>
</fieldset>
<div id="field_10_43" class="gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_10_43"><br></div>
<div id="field_10_28" class="gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_28">
<h3 class="gsection_title fusion-responsive-typography-calculated" data-fontsize="24" style="--fontSize: 24; line-height: 1.15; --minFontSize: 24;" data-lineheight="27.6px">I would like to nominate the following person for the
Service-Learning Practitioner Leadership Award</h3>
</div>
<fieldset id="field_10_29" class="gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_29">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Nominee Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_10_29">
<span id="input_10_29_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_29.3" id="input_10_29_3" value="" aria-required="true">
<label for="input_10_29_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_10_29_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_29.6" id="input_10_29_6" value="" aria-required="true">
<label for="input_10_29_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</fieldset>
<div id="field_10_30" class="gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_30"><label
class="gfield_label gform-field-label" for="input_10_30">Title<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_30" id="input_10_30" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_10_31" class="gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_31"><label
class="gfield_label gform-field-label" for="input_10_31">Organization/School<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_31" id="input_10_31" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_10_32" class="gfield gfield--type-email gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_32"><label
class="gfield_label gform-field-label" for="input_10_32">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_32" id="input_10_32" type="email" value="" class="large" aria-required="true" aria-invalid="false">
</div>
</div>
<div id="field_10_33" class="gfield gfield--type-phone gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_33"><label
class="gfield_label gform-field-label" for="input_10_33">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_33" id="input_10_33" type="tel" value="" class="large" aria-required="true" aria-invalid="false"></div>
</div>
<fieldset id="field_10_34" class="gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_34">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row" id="input_10_34">
<span class="ginput_full address_line_1 ginput_address_line_1 gform-grid-col" id="input_10_34_1_container">
<label for="input_10_34_1" id="input_10_34_1_label" class="gform-field-label gform-field-label--type-sub ">Street Address</label>
<input type="text" name="input_34.1" id="input_10_34_1" value="" aria-required="true">
</span><span class="ginput_full address_line_2 ginput_address_line_2 gform-grid-col" id="input_10_34_2_container">
<label for="input_10_34_2" id="input_10_34_2_label" class="gform-field-label gform-field-label--type-sub ">Address Line 2</label>
<input type="text" name="input_34.2" id="input_10_34_2" value="" aria-required="false">
</span><span class="ginput_left address_city ginput_address_city gform-grid-col" id="input_10_34_3_container">
<label for="input_10_34_3" id="input_10_34_3_label" class="gform-field-label gform-field-label--type-sub ">City</label>
<input type="text" name="input_34.3" id="input_10_34_3" value="" aria-required="true">
</span><span class="ginput_right address_state ginput_address_state gform-grid-col" id="input_10_34_4_container">
<label for="input_10_34_4" id="input_10_34_4_label" class="gform-field-label gform-field-label--type-sub ">State / Province / Region</label>
<input type="text" name="input_34.4" id="input_10_34_4" value="" aria-required="true">
</span><span class="ginput_left address_zip ginput_address_zip gform-grid-col" id="input_10_34_5_container">
<label for="input_10_34_5" id="input_10_34_5_label" class="gform-field-label gform-field-label--type-sub ">ZIP / Postal Code</label>
<input type="text" name="input_34.5" id="input_10_34_5" value="" aria-required="true">
</span><span class="ginput_right address_country ginput_address_country gform-grid-col" id="input_10_34_6_container">
<label for="input_10_34_6" id="input_10_34_6_label" class="gform-field-label gform-field-label--type-sub ">Country</label>
<div class="gravity-select-parent"><select name="input_34.6" id="input_10_34_6" aria-required="true">
<option value="" selected="selected"></option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
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<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
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<option value="El Salvador">El Salvador</option>
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<option value="Holy See">Holy See</option>
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<option value="Hong Kong">Hong Kong</option>
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<option value="Iraq">Iraq</option>
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<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
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<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Macedonia">North Macedonia</option>
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<option value="Panama">Panama</option>
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<option value="Qatar">Qatar</option>
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<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten">Sint Maarten</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
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<option value="Spain">Spain</option>
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<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
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<option value="Switzerland">Switzerland</option>
<option value="Syria Arab Republic">Syria Arab Republic</option>
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<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, the United Republic of">Tanzania, the United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Türkiye">Türkiye</option>
<option value="US Minor Outlying Islands">US Minor Outlying Islands</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
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<input type="button" id="gform_next_button_10_41" class="gform_next_button gform-theme-button button" value="Next"
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<div id="field_10_35" class="gfield gfield--type-section gsection field_sublabel_above gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_10_35">
<h3 class="gsection_title fusion-responsive-typography-calculated" data-fontsize="24" style="--fontSize: 24; line-height: 1.15; --minFontSize: 24;" data-lineheight="27.6px">Complete the Following Questions</h3>
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<div id="field_10_36" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_36"><label
class="gfield_label gform-field-label" for="input_10_36">Why are you nominating this person for this award?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_36" id="input_10_36" class="textarea large" maxlength="300" aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
<div class="charleft ginput_counter gfield_description" aria-live="polite">0 of 300 max characters</div>
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</div>
<div id="field_10_39" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_39"><label
class="gfield_label gform-field-label" for="input_10_39">List specific organizations, schools, and agencies where the nominee has worked as a service-learning practitioner. Please specify how long the nominee worked with each
organization.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_39" id="input_10_39" class="textarea large" maxlength="300" aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
<div class="charleft ginput_counter gfield_description" aria-live="polite">0 of 300 max characters</div>
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<div id="field_10_40" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_40"><label
class="gfield_label gform-field-label" for="input_10_40">How has your nominee implemented and integrated service-learning in their school setting? Be sure to include examples of how they incorporated core components of
service-learning.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_40" id="input_10_40" class="textarea large" maxlength="300" aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
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<div id="field_10_42" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_10_42"><label
class="gfield_label gform-field-label" for="input_10_42">How has the nominee’s model of leadership nurtured others in the field, helping them to understand service-learning and become service-learning practitioners?<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_42" id="input_10_42" class="textarea large" maxlength="300" aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
<div class="charleft ginput_counter gfield_description" aria-live="polite">0 of 300 max characters</div>
</div>
</div>
<div id="field_10_37" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible" data-js-reload="field_10_37"><label
class="gfield_label gform-field-label" for="input_10_37">Describe how the nominee has had an impact on the field of service-learning in a minimum of two of the areas below:<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="gfield_description" id="gfield_description_10_37">Policy Development | Written Works | Research that has Advanced Service-Learning | Replicable Program Model Development | National Advocacy</div>
<div class="ginput_container ginput_container_textarea"><textarea name="input_37" id="input_10_37" class="textarea large" aria-describedby="gfield_description_10_37" maxlength="300"
placeholder="Be specific about the scope and scale of the nominee's work." aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
<div class="charleft ginput_counter gfield_description" aria-live="polite">0 of 300 max characters</div>
</div>
</div>
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<h3 class="gsection_title fusion-responsive-typography-calculated" data-fontsize="24" style="--fontSize: 24; line-height: 1.15; --minFontSize: 24;" data-lineheight="27.6px">Next Steps: Sync an Email Add-On</h3>
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</div>
</fieldset>
<div id="field_9_23" class="gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_23"><label
class="gfield_label gform-field-label" for="input_9_23">Title<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_23" id="input_9_23" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_9_24" class="gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_24"><label
class="gfield_label gform-field-label" for="input_9_24">Organization/School<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_24" id="input_9_24" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_9_1" class="gfield gfield--type-email gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_1"><label
class="gfield_label gform-field-label" for="input_9_1">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_1" id="input_9_1" type="email" value="" class="large" aria-required="true" aria-invalid="false">
</div>
</div>
<div id="field_9_26" class="gfield gfield--type-phone gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_26"><label
class="gfield_label gform-field-label" for="input_9_26">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_26" id="input_9_26" type="tel" value="" class="large" aria-required="true" aria-invalid="false"></div>
</div>
<fieldset id="field_9_25" class="gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_25">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row" id="input_9_25">
<span class="ginput_full address_line_1 ginput_address_line_1 gform-grid-col" id="input_9_25_1_container">
<label for="input_9_25_1" id="input_9_25_1_label" class="gform-field-label gform-field-label--type-sub ">Street Address</label>
<input type="text" name="input_25.1" id="input_9_25_1" value="" aria-required="true">
</span><span class="ginput_full address_line_2 ginput_address_line_2 gform-grid-col" id="input_9_25_2_container">
<label for="input_9_25_2" id="input_9_25_2_label" class="gform-field-label gform-field-label--type-sub ">Address Line 2</label>
<input type="text" name="input_25.2" id="input_9_25_2" value="" aria-required="false">
</span><span class="ginput_left address_city ginput_address_city gform-grid-col" id="input_9_25_3_container">
<label for="input_9_25_3" id="input_9_25_3_label" class="gform-field-label gform-field-label--type-sub ">City</label>
<input type="text" name="input_25.3" id="input_9_25_3" value="" aria-required="true">
</span><span class="ginput_right address_state ginput_address_state gform-grid-col" id="input_9_25_4_container">
<label for="input_9_25_4" id="input_9_25_4_label" class="gform-field-label gform-field-label--type-sub ">State / Province / Region</label>
<input type="text" name="input_25.4" id="input_9_25_4" value="" aria-required="true">
</span><span class="ginput_left address_zip ginput_address_zip gform-grid-col" id="input_9_25_5_container">
<label for="input_9_25_5" id="input_9_25_5_label" class="gform-field-label gform-field-label--type-sub ">ZIP / Postal Code</label>
<input type="text" name="input_25.5" id="input_9_25_5" value="" aria-required="true">
</span><span class="ginput_right address_country ginput_address_country gform-grid-col" id="input_9_25_6_container">
<label for="input_9_25_6" id="input_9_25_6_label" class="gform-field-label gform-field-label--type-sub ">Country</label>
<div class="gravity-select-parent"><select name="input_25.6" id="input_9_25_6" aria-required="true">
<option value="" selected="selected"></option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cabo Verde">Cabo Verde</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos Islands">Cocos Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic of the">Congo, Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czechia">Czechia</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Eswatini">Eswatini</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See">Holy See</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Macedonia">North Macedonia</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Réunion">Réunion</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin">Saint Martin</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten">Sint Maarten</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria Arab Republic">Syria Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, the United Republic of">Tanzania, the United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Türkiye">Türkiye</option>
<option value="US Minor Outlying Islands">US Minor Outlying Islands</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="Åland Islands">Åland Islands</option>
</select>
<div class="select-arrow" style="height: 38px; width: 38px; line-height: 38px; left: 272.703px;"></div>
</div>
</span>
<div class="gf_clear gf_clear_complex"></div>
</div>
</fieldset>
<div id="field_9_42" class="gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_9_42"><br></div>
<div id="field_9_28" class="gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_28">
<h3 class="gsection_title fusion-responsive-typography-calculated" data-fontsize="24" style="--fontSize: 24; line-height: 1.15; --minFontSize: 24;" data-lineheight="27.6px">I would like to nominate the following person for the Alec
Dickson Servant Leader Award</h3>
</div>
<fieldset id="field_9_29" class="gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_29">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Nominee Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_9_29">
<span id="input_9_29_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_29.3" id="input_9_29_3" value="" aria-required="true">
<label for="input_9_29_3" class="gform-field-label gform-field-label--type-sub ">First</label>
</span>
<span id="input_9_29_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<input type="text" name="input_29.6" id="input_9_29_6" value="" aria-required="true">
<label for="input_9_29_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
</span>
</div>
</fieldset>
<div id="field_9_30" class="gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_30"><label
class="gfield_label gform-field-label" for="input_9_30">Title<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_30" id="input_9_30" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_9_31" class="gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_31"><label
class="gfield_label gform-field-label" for="input_9_31">Organization/School<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_31" id="input_9_31" type="text" value="" class="large" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_9_32" class="gfield gfield--type-email gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_32"><label
class="gfield_label gform-field-label" for="input_9_32">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_32" id="input_9_32" type="email" value="" class="large" aria-required="true" aria-invalid="false">
</div>
</div>
<div id="field_9_33" class="gfield gfield--type-phone gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_33"><label
class="gfield_label gform-field-label" for="input_9_33">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_33" id="input_9_33" type="tel" value="" class="large" aria-required="true" aria-invalid="false"></div>
</div>
<fieldset id="field_9_34" class="gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_34">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row" id="input_9_34">
<span class="ginput_full address_line_1 ginput_address_line_1 gform-grid-col" id="input_9_34_1_container">
<label for="input_9_34_1" id="input_9_34_1_label" class="gform-field-label gform-field-label--type-sub ">Street Address</label>
<input type="text" name="input_34.1" id="input_9_34_1" value="" aria-required="true">
</span><span class="ginput_full address_line_2 ginput_address_line_2 gform-grid-col" id="input_9_34_2_container">
<label for="input_9_34_2" id="input_9_34_2_label" class="gform-field-label gform-field-label--type-sub ">Address Line 2</label>
<input type="text" name="input_34.2" id="input_9_34_2" value="" aria-required="false">
</span><span class="ginput_left address_city ginput_address_city gform-grid-col" id="input_9_34_3_container">
<label for="input_9_34_3" id="input_9_34_3_label" class="gform-field-label gform-field-label--type-sub ">City</label>
<input type="text" name="input_34.3" id="input_9_34_3" value="" aria-required="true">
</span><span class="ginput_right address_state ginput_address_state gform-grid-col" id="input_9_34_4_container">
<label for="input_9_34_4" id="input_9_34_4_label" class="gform-field-label gform-field-label--type-sub ">State / Province / Region</label>
<input type="text" name="input_34.4" id="input_9_34_4" value="" aria-required="true">
</span><span class="ginput_left address_zip ginput_address_zip gform-grid-col" id="input_9_34_5_container">
<label for="input_9_34_5" id="input_9_34_5_label" class="gform-field-label gform-field-label--type-sub ">ZIP / Postal Code</label>
<input type="text" name="input_34.5" id="input_9_34_5" value="" aria-required="true">
</span><span class="ginput_right address_country ginput_address_country gform-grid-col" id="input_9_34_6_container">
<label for="input_9_34_6" id="input_9_34_6_label" class="gform-field-label gform-field-label--type-sub ">Country</label>
<div class="gravity-select-parent"><select name="input_34.6" id="input_9_34_6" aria-required="true">
<option value="" selected="selected"></option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cabo Verde">Cabo Verde</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos Islands">Cocos Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic of the">Congo, Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czechia">Czechia</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Eswatini">Eswatini</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See">Holy See</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Macedonia">North Macedonia</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Réunion">Réunion</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin">Saint Martin</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten">Sint Maarten</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria Arab Republic">Syria Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, the United Republic of">Tanzania, the United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Türkiye">Türkiye</option>
<option value="US Minor Outlying Islands">US Minor Outlying Islands</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="Åland Islands">Åland Islands</option>
</select>
<div class="select-arrow" style="height: 38px; width: 38px; line-height: 38px; left: 272.703px;"></div>
</div>
</span>
<div class="gf_clear gf_clear_complex"></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_page_footer top_label">
<input type="button" id="gform_next_button_9_41" class="gform_next_button gform-theme-button button" value="Next"
onclick="jQuery("#gform_target_page_number_9").val("2"); jQuery("#gform_9").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("2"); jQuery("#gform_9").trigger("submit",[true]); } ">
</div>
</div>
<div id="gform_page_9_2" class="gform_page" data-js="page-field-id-41" style="display:none;">
<div class="gform_page_fields">
<div id="gform_fields_9_2" class="gform_fields top_label form_sublabel_above description_below">
<div id="field_9_35" class="gfield gfield--type-section gsection field_sublabel_above gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_9_35">
<h3 class="gsection_title fusion-responsive-typography-calculated" data-fontsize="24" style="--fontSize: 24; line-height: 1.15; --minFontSize: 24;" data-lineheight="27.6px">Complete the Following Questions</h3>
<div class="gsection_description" id="gfield_description_9_35">Please keep each response under 1,500 characters.</div>
</div>
<div id="field_9_36" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_36"><label
class="gfield_label gform-field-label" for="input_9_36">Explain, with examples, how the nominee has demonstrated the leadership characteristics of courage, creativity, and compassion in his or her work.<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_36" id="input_9_36" class="textarea large" maxlength="1500" aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
<div class="charleft ginput_counter gfield_description" aria-live="polite">0 of 1500 max characters</div>
</div>
</div>
<div id="field_9_37" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible" data-js-reload="field_9_37"><label
class="gfield_label gform-field-label" for="input_9_37">Describe how the nominee has had an impact on the field of service-learning in a minimum of two of the areas below:<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="gfield_description" id="gfield_description_9_37">Policy Development | Written Works | Research that has Advanced Service-Learning | Replicable Program Model Development | International Advocacy | Financial Support</div>
<div class="ginput_container ginput_container_textarea"><textarea name="input_37" id="input_9_37" class="textarea large" aria-describedby="gfield_description_9_37" maxlength="1500"
placeholder="Be specific about the scope and scale of the nominee's work." aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
<div class="charleft ginput_counter gfield_description" aria-live="polite">0 of 1500 max characters</div>
</div>
</div>
<div id="field_9_39" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_39"><label
class="gfield_label gform-field-label" for="input_9_39">How has the nominee’s model of leadership helped nurture others in the field to understand and become service-learning practitioners?<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_39" id="input_9_39" class="textarea large" maxlength="1500" aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
<div class="charleft ginput_counter gfield_description" aria-live="polite">0 of 1500 max characters</div>
</div>
</div>
<div id="field_9_40" class="gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_40"><label
class="gfield_label gform-field-label" for="input_9_40">List specific organizations, schools, and agencies where the nominee has served, with approximate dates.<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_40" id="input_9_40" class="textarea large" maxlength="1500" aria-required="true" aria-invalid="false" rows="10" cols="50"></textarea>
<div class="charleft ginput_counter gfield_description" aria-live="polite">0 of 1500 max characters</div>
</div>
</div>
<div id="field_9_22" class="gfield gfield--type-fileupload gfield--width-full field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_22"><label
class="gfield_label gform-field-label" for="html5_1hkujm0k8ikn11rok6b1f6i9af3">Please attach three letters of reference, at least two of which are from outside the nominee’s organization.</label>
<div class="ginput_container ginput_container_fileupload">
<div id="gform_multifile_upload_9_22"
data-settings="{"runtimes":"html5,flash,html4","browse_button":"gform_browse_button_9_22","container":"gform_multifile_upload_9_22","drop_element":"gform_drag_drop_area_9_22","filelist":"gform_preview_9_22","unique_names":true,"file_data_name":"file","url":"https:\/\/nylc.org\/?gf_page=9c02a373fbd0317","flash_swf_url":"https:\/\/nylc.org\/wp-includes\/js\/plupload\/plupload.flash.swf","silverlight_xap_url":"https:\/\/nylc.org\/wp-includes\/js\/plupload\/plupload.silverlight.xap","filters":{"mime_types":[{"title":"Allowed Files","extensions":"*"}],"max_file_size":"2146435072b"},"multipart":true,"urlstream_upload":false,"multipart_params":{"form_id":9,"field_id":22},"gf_vars":{"max_files":"3","message_id":"gform_multifile_messages_9_22","disallowed_extensions":["php","asp","aspx","cmd","csh","bat","html","htm","hta","jar","exe","com","js","lnk","htaccess","phtml","ps1","ps2","php3","php4","php5","php6","py","rb","tmp"]}}"
class="gform_fileupload_multifile" style="position: relative;">
<div id="gform_drag_drop_area_9_22" class="gform_drop_area gform-theme-field-control" style="position: relative;">
<span class="gform_drop_instructions">Drop files here or </span>
<button type="button" id="gform_browse_button_9_22" class="button gform_button_select_files gform-theme-button gform-theme-button--control" aria-describedby="gfield_upload_rules_9_22"
aria-label="select files, please attach three letters of reference, at least two of which are from outside the nominee’s organization." style="z-index: 1;">Select files</button>
</div>
<div id="html5_1hkujm0k8ikn11rok6b1f6i9af3_container" class="moxie-shim moxie-shim-html5" style="position: absolute; top: 0px; left: 0px; width: 0px; height: 0px; overflow: hidden; z-index: 0;"><input
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</div><span class="gfield_description gform_fileupload_rules" id="gfield_upload_rules_9_22">Max. file size: 2 GB, Max. files: 3.</span>
<ul class="validation_message--hidden-on-empty gform-ul-reset" id="gform_multifile_messages_9_22"></ul> <!-- Leave <ul> empty to support CSS :empty selector. -->
</div>
<div id="gform_preview_9_22" class="ginput_preview_list"></div>
</div>
<div id="field_9_43" class="gfield gfield--type-captcha gfield--width-full field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_9_43"><label
class="gfield_label gform-field-label" for="input_9_43">CAPTCHA</label>
<div id="input_9_43" class="ginput_container ginput_recaptcha gform-initialized" data-sitekey="6LenftwlAAAAADCMsZ_uE-HYEDQ7xRrO-Smr9rYc" data-theme="light" data-tabindex="0" data-badge="">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-o6zi3wmh5diw" frameborder="0" scrolling="no"
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</div><textarea id="g-recaptcha-response-2" name="g-recaptcha-response" class="g-recaptcha-response"
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</div><iframe style="display: none;"></iframe>
</div>
</div>
<div id="field_9_44" class="gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_below gfield_visibility_visible" data-js-reload="field_9_44"><label
class="gfield_label gform-field-label" for="input_9_44">Email</label>
<div class="ginput_container"><input name="input_44" id="input_9_44" type="text" value="" autocomplete="new-password"></div>
<div class="gfield_description" id="gfield_description_9_44">This field is for validation purposes and should be left unchanged.</div>
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* Why?
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* Education Equity
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* Events
* National Service-Learning Conference®
April 3-6, 2024
* Youth Leadership Summit
April 3, 2024
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See you in 2024!
* More Events & Workshops
PROFESSIONAL DEVELOPMENT, EVENTS, & WORKSHOPS
View our three annual events to the left and more opportunities below!
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Homeameuersnylcorg2023-09-12T19:04:23-05:00
SERVE. LEARN. CHANGE THE WORLD.®
WE ARE ON A MISSION TO CREATE A MORE JUST, SUSTAINABLE, AND PEACEFUL WORLD WITH
YOUNG PEOPLE, THEIR SCHOOLS, AND THEIR COMMUNITIES THROUGH SERVICE-LEARNING.
WE ARE ON A MISSION TO CREATE A MORE JUST, SUSTAINABLE, AND PEACEFUL WORLD WITH
YOUNG PEOPLE, THEIR SCHOOLS, AND THEIR COMMUNITIES THROUGH SERVICE-LEARNING.
OUR VISION
Our vision is that all young people become civically informed and engaged global
citizens by participating in service-learning during their formative years.
We train young leaders by tapping into their passions to address real world
issues. Whether their goals are to improve their communities, promote safe
driving, or reform education, we empower youth to Serve. Learn. Change the
world.®
We are a force in the development and advancement of youth civic engagement
through service-learning, and the national expert on service-learning as a tool
to engage young people. For over 40 years, NYLC has empowered young people to
provide meaningful service to their communities, develop life skills, and be
civically engaged citizens of the world.
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“I think students see hope when they’re engaged in service-learning.”
Elaine Fitzgerald
Principal, Satellite Center, St. Charles Parish, Louisiana
“In service-learning we’re design thinking and problem-solving all the way.”
Brian Gough
Digital Media instructor, Satellite Center, St. Charles Parish, Louisiana
“It doesn’t feel like school. It feels like you’re making a difference in the
world.”
Logan Sampey
Student, Satellite Center, St. Charles Parish, Louisiana
OUR 2022 IMPACT
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youth equipped with the tools to be leaders of positive change.
0K
educators trained to improve their service-learning practice.
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countries supported by the work of NYLC.
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SERVICE-LEARNING PRACTITIONER LEADERSHIP AWARD NOMINATION
Please fill out the form below to nominate an individual for the
Service-Learning Practitioner Leadership Award.
"*" indicates required fields
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Nominator Name*
First Last
Title*
Organization/School*
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Country
AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua
and
BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire,
Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish
Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo
VerdeCambodiaCameroonCanadaCayman IslandsCentral African
RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo,
Democratic Republic of theCook IslandsCosta
RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican
RepublicEcuadorEgyptEl SalvadorEquatorial
GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe
IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern
TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard
Island and McDonald IslandsHoly SeeHondurasHong
KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of
ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic
People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic
RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew
CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth
MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State
ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto
RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena,
Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint
Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and
PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint
MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the
South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan
MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United
Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and
TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying
IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited
StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin
Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands
I WOULD LIKE TO NOMINATE THE FOLLOWING PERSON FOR THE SERVICE-LEARNING
PRACTITIONER LEADERSHIP AWARD
Nominee Name*
First Last
Title*
Organization/School*
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Country
AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua
and
BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire,
Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish
Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo
VerdeCambodiaCameroonCanadaCayman IslandsCentral African
RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo,
Democratic Republic of theCook IslandsCosta
RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican
RepublicEcuadorEgyptEl SalvadorEquatorial
GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe
IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern
TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard
Island and McDonald IslandsHoly SeeHondurasHong
KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of
ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic
People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic
RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew
CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth
MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State
ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto
RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena,
Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint
Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and
PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint
MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the
South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan
MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United
Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and
TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying
IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited
StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin
Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands
COMPLETE THE FOLLOWING QUESTIONS
Please keep each response under 300 words.
Why are you nominating this person for this award?*
0 of 300 max characters
List specific organizations, schools, and agencies where the nominee has worked
as a service-learning practitioner. Please specify how long the nominee worked
with each organization.*
0 of 300 max characters
How has your nominee implemented and integrated service-learning in their school
setting? Be sure to include examples of how they incorporated core components of
service-learning.*
0 of 300 max characters
How has the nominee’s model of leadership nurtured others in the field, helping
them to understand service-learning and become service-learning practitioners?*
0 of 300 max characters
Describe how the nominee has had an impact on the field of service-learning in a
minimum of two of the areas below:*
Policy Development | Written Works | Research that has Advanced Service-Learning
| Replicable Program Model Development | National Advocacy
0 of 300 max characters
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ALEC DICKSON SERVANT LEADER AWARD NOMINATION
Please fill out the form below to nominate an individual for the Alec Dickson
Servant Leader Award.
"*" indicates required fields
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Nominator Name*
First Last
Title*
Organization/School*
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Country
AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua
and
BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire,
Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish
Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo
VerdeCambodiaCameroonCanadaCayman IslandsCentral African
RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo,
Democratic Republic of theCook IslandsCosta
RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican
RepublicEcuadorEgyptEl SalvadorEquatorial
GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe
IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern
TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard
Island and McDonald IslandsHoly SeeHondurasHong
KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of
ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic
People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic
RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew
CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth
MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State
ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto
RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena,
Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint
Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and
PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint
MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the
South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan
MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United
Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and
TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying
IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited
StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin
Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands
I WOULD LIKE TO NOMINATE THE FOLLOWING PERSON FOR THE ALEC DICKSON SERVANT
LEADER AWARD
Nominee Name*
First Last
Title*
Organization/School*
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Country
AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua
and
BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire,
Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish
Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo
VerdeCambodiaCameroonCanadaCayman IslandsCentral African
RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo,
Democratic Republic of theCook IslandsCosta
RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican
RepublicEcuadorEgyptEl SalvadorEquatorial
GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe
IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern
TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard
Island and McDonald IslandsHoly SeeHondurasHong
KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of
ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic
People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic
RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew
CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth
MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State
ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto
RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena,
Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint
Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and
PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint
MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the
South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan
MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United
Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and
TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying
IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited
StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin
Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands
COMPLETE THE FOLLOWING QUESTIONS
Please keep each response under 1,500 characters.
Explain, with examples, how the nominee has demonstrated the leadership
characteristics of courage, creativity, and compassion in his or her work.*
0 of 1500 max characters
Describe how the nominee has had an impact on the field of service-learning in a
minimum of two of the areas below:*
Policy Development | Written Works | Research that has Advanced Service-Learning
| Replicable Program Model Development | International Advocacy | Financial
Support
0 of 1500 max characters
How has the nominee’s model of leadership helped nurture others in the field to
understand and become service-learning practitioners?*
0 of 1500 max characters
List specific organizations, schools, and agencies where the nominee has served,
with approximate dates.*
0 of 1500 max characters
Please attach three letters of reference, at least two of which are from outside
the nominee’s organization.
Drop files here or Select files
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