Developing a more diverse and inclusive community, one leader at a time.

Class of 2021 MCLP Participant Nomination Form

The mission of MCLP is to develop leaders to engage the power of diverse perspectives to improve our world.

Applicants must be 21 or older and live or work in McLean County. The ideal candidate has a passion to improve their leadership skills and an openness to working with others with diverse perspectives. Candidates should either be in a current leadership role, or show a high potential for leadership.

Click here for more information on applications and recruitment receptions.

If you have questions, please contact us:

Julie Emig, Executive Director at JEmig@bn-mclp.org, 309-556-3651

Nominee Information (Please tell us about the person you are nominating for MCLP.)

Nominee-First Name *

Nominee-Last Name *

Organization

Position

Phone Number

Phone Type

Phone Location

Email Location

Please complete the phone and/or email information for your nominee. If neither are available, please call 309-556-3589 with nominee information or forward the recruitment reception link directly to your nominee.

Is the nominee interested in participating in the program?

Yes

Not sure

I know the applicant:

Very well

Fairly well

Not very well

Describe how you know the nominee (in what context / how long, etc.)

Please check the column that most accurately reflects your assessment of the nominee.

Superior = outstanding excellence of this nominee. Excellent = a strong rating. Good, Fair, and Not Acceptable (NA) are self-explanatory.

Leadership Assessment Grid

	Superior	Excellent	Good	Fair	NA
Esteem in which he/she is held professionally	Esteem in which he/she is held professionally - Superior	Esteem in which he/she is held professionally - Excellent	Esteem in which he/she is held professionally - Good	Esteem in which he/she is held professionally - Fair	Esteem in which he/she is held professionally - NA
Demonstrated leadership	Demonstrated leadership - Superior	Demonstrated leadership - Excellent	Demonstrated leadership - Good	Demonstrated leadership - Fair	Demonstrated leadership - NA
Currently handles leadership demands	Currently handles leadership demands - Superior	Currently handles leadership demands - Excellent	Currently handles leadership demands - Good	Currently handles leadership demands - Fair	Currently handles leadership demands - NA
Ability to work with others	Ability to work with others - Superior	Ability to work with others - Excellent	Ability to work with others - Good	Ability to work with others - Fair	Ability to work with others - NA
Ability to communicate	Ability to communicate - Superior	Ability to communicate - Excellent	Ability to communicate - Good	Ability to communicate - Fair	Ability to communicate - NA
Passion for becoming a better leader	Passion for becoming a better leader - Superior	Passion for becoming a better leader - Excellent	Passion for becoming a better leader - Good	Passion for becoming a better leader - Fair	Passion for becoming a better leader - NA
Overall leadership potential	Overall leadership potential - Superior	Overall leadership potential - Excellent	Overall leadership potential - Good	Overall leadership potential - Fair	Overall leadership potential - NA

Please explain why you believe this nominee and our community will benefit through his or her participation in MCLP

Do you have any additional observations about this individual that you would like to share?

Signature *

Type your name

Date *

Month

Day

Year

Nominator Information (Please tell us about you.)

First Name *

Last Name *

Organization

Position

Preferred Phone Number

Phone Type

Phone Location

Preferred Email *

Email Location *

May we use your name when sending the nominee an invitation to the MCLP recruitment reception?

Yes

Thank you for completing this nomination.

We appreciate your nomination of a potential MCLP candidate. Your nominee will be asked to submit an online application by May 31 and then complete an in-person interview in order to be considered. After the interviews, 24 - 26 participants will be selected for MCLP which runs July, 2020 – March, 2021. Although we cannot guarantee the nominee will be selected this year, we will give them full consideration.

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Class of 2021 MCLP Participant Nomination Form