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ALF Nomination Form for
Fellows Program

Questions marked with an asterisk (*) are mandatory.

* Name of nominee : 
Title : 
Company/organization : 
Address : 
Telephone : 
Email : 
Please comment on the ALF Fellow candidate's commitment level : 
 High  Medium  Low
Please comment on the ALF Fellow candidate's influence level : 
 High  Medium  Low
Candidate's evidence of demonstrated leadership : 
Candidate's professional strengths : 
Noteworthy examples of candidate's community-related accomplishments include : 
OPTIONAL--For the diversity matrix, note ethnic background : 
Gender : 
 Male
 Female
Nominee's area of interest or affiliation : 
* Your name : 
Are you an ALF Senior Fellow?
 Yes  No
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