Awards Nomination Form - LeadingAge North Carolina

Expanding the World of Possibilities for Aging

2025 Awards Nomination Form

Please complete the nomination form below.

NOMINEE INFORMATION
Nomination is for *	Career Excellence Award for Lifetime Achievement Excellence in Leadership Excellence in Governance Excellence in Community Service The Service Excellence Award Excellence in Innovation Excellence in Advocacy Workplace Excellence
Please include the name and contact information for the person you are nominating below.
Name of Nominee *
Nominee Community *
Nominee Address *
Nominee City *
Nominee State *		Nominee Zip Code *
Nominee Phone *		Nominee Email *
SUBMITTED BY
Please include your contact information below.
Submitter Name *
Submitter Community *
Submitter Address *
Submitter City *
Submitter State *		Submitter Zip Code *
Submitter Phone *		Submitter Email *
Paste one-page descriptionPlease paste a one-page description for your nomination. Be sure to include the nominee's name and the name of the award at the top of your description.
Upload a headshot of the nominee or photo representing the organization or programPlease upload photo in jpeg. format, or email your image to info@leadingagenc.org.
Thank You For Your Nomination
“Once you press “Submit", you will receive an automated confirmation email response from our system. Sometimes these automated responses get sent to spam or junk email folders so please check there. If you do not receive the automated email, please feel free to contact our office to confirm receipt at (919) 571-8333 or info@leadingagenc.org.