Application for Nomination
National Student Leadership Forum on Faith and Values
September 25-27, 2009
The National Student Leadership Forum is a three-day annual event held in the fall that brings
together a diverse group of university leaders from across the country. The program for the
Forum is intentionally relational. Students will interact with fellow students, recent college
graduates, young professionals and established adults from the political, business and social
service sectors of society. Though the specifics of the forum shift slightly from year to year, core
activities include keynote speeches by various political leaders, small group breakout sessions
after larger meetings, panel discussions and more. Loyola has been invited to nominate two or
three of our students to be considered for this year’s Forum.
Students are nominated to participate by leaders on their campuses and communities. In order to
be considered for nomination, please complete the attached questionnaire and return it to Jack
McLean, Director of Student Leadership Development, CFSU 101, email@example.com, 773-508-
3912, before 5:00 p.m., Friday, April 24. Depending on the number of applications, the
Department of Student Leadership Development may utilize this questionnaire to select students
for interviews. For more information about the Forum, please see
Application for Nomination
National Student Leadership Forum on Faith and Values 2009
(As listed on your driver’s license or other government issued photo ID)
Preferred Phone Number: __________________________
Cell Phone (if any):____________________________
Best E-mail contact: ____________________________
How many years have you attended Loyola? ____________
How many more years do you anticipate attending Loyola as an undergraduate? __________
Current Year (freshman, sophomore, junior) ________________________
____ Yes, if nominated and selected, I expect to be available to attend the National Student
Leadership Forum on Faith and Values, September 25-27, 2009 in Washington, D.C. and, I will
commit myself to attending the entire conference.
____ Yes, I plan to stay and graduate from Loyola University Chicago. My expected graduation
date is _______________________________________.
Please list your involvement in activities—and highlight any leadership experiences—at Loyola
University Chicago and/or the local community since you arrived:
Please list your planned future involvement in the Loyola University Chicago community:
Why would you like to participate in either of these summer leadership conferences?
If you were selected to participate in either of these summer leadership conferences, how would
you use that experience to benefit the Loyola University Chicago community?
The name, phone number and e-mail address of a Loyola faculty or staff member who would
serve as an oral reference for my application are: _____________________________________.
(Written references letters are not expected or requested). Applications will not be considered
unless this reference is provided.
If finalists are interviewed, I would be available for interviews at the following times (please
indicate available times):
Wednesday, April 29, 9:00 a.m. – 5:00 p.m.
Please return this application to Jack McLean, Director of Student Leadership Development,
CFSU 101, firstname.lastname@example.org, 773-508-3912, fax 773-508-3895, before 5:00 p.m., Friday, April
24. Electronic submissions via e-mail are encouraged.