2021-2023 NPHC LC Officers Nomination Form

1. Please select the position to which you are nominating a candidate to serve for the 2019-2021 term:*

2. Name of Nominee

Full Name*

PrefixFirst NameMiddle NameLast Name

3. Please provide the nominees' member organization.*

ZUL Chapter, Alpha Phi Alpha Fraternity, Inc.PRO Chapter, Alpha Kappa Alpha Sorority, Inc.DLAC, Kappa Alpha Psi Fraternity, Inc.SMM Chapter, Omega Psi Phi Fraternity, Inc.LCAC, Delta Sigma Theta Sorority, Inc.RKS Chapter, Phi Beta Sigma Fraternity, Inc.PUZ Chapter, Zeta Phi Beta Sorority, Inc.

4. Please provide contact information for your nominee:

Email*

example@example.com

Phone Number*

Area CodePhone Number

5. Please select an alternate position for this nominee. (not required)

To your knowledge, has the nominee previously been involved in NPHC LC activities?

YesNoNot Sure

Your Name

First NameLast Name

E-mail address

Thank you for submitting a candidate for nomination to the 2019-2021 NPHC LC Executive Council. Your submission will be submitted to the nominee's chapter president for final approval in accordance with council bylaws. The slate will be presented at the April 2019 NPHC LC Executive Council meeting and elections will be held at the May 2019 NPHC LC General Body meeting. Please plan to attend.

Once you complete this form, click on the "Submit" button below. This will then email you a copy of the submission, which is also emailed to the Nominating Chair.

NPHC Loudoun County