Nomination Form

Complete the Nomination form below and click the Submit button when finished. Upon acceptance to this program, payment will be processed per the Registration Agreement, which must also be completed and faxed to 916-278-4865 in order to make this nomination valid. Contact the College of Continuing Education at (916) 278-4433 for any questions.

*Required Fields

Nominee
  Formal Name (this name will appear on formal documents, i.e., certificate)
First Name   Last Name
*   *
 
  Preferred Name (for nametags and class rosters):
* 		 
  Working Title
* 		 
 
Agency / Department / Organization
*		   Division
*		   Office/Unit
 
 
Civil Service Classification
*		     If "Other" was selected, please type in the Nominee's classification:

 
  Mailing Address
*		  
 
City   State   Zip
*   *   *
 
  Telephone
*		  
  Email
* 		 
  How did you hear about the Leadership for the Government Executive Program?
*		  
     
Nominee Demographic Information
  Gender
* 		 
 

Sacramento State University Alum? *
Yes    No

  
  Highest Level of Education
*		  
     
Position
  Please select the nominee's current position: *
IT
Programming
Executive		  
  Description of current executive and/or enterprise level duties: *
  
  List of previous government experience and dates: *
  
     
Nominee's Manager
 
First Name   Last Name
*   *
 
  Working Title
*
  
 
Agency / Department / Organization
*		   Division
*		   Office/Unit
 
  Civil Service Classification (Please type in)
*		  
  Mailing Address
*		  
 
City   State   Zip
*   *   *
 
  Telephone
*		  
  Email
*		  
 

Briefly state the objectives and reasons for nominating this individual: *

  
     
Nominee's Sponsor
  If same as Nominee's Manager, click here and proceed to the next section.  
 
First Name   Last Name
*   *
 
  Working Title
*		  
 
Agency / Department / Organization
*		   Division
*		   Office/Unit
 
  Civil Service Classification (Please type in)
*		  
  Mailing Address
*		  
 
City   State   Zip
*   *   *
 
  Telephone
*		  
  Email
*		  
 

Check here if the Sponsor is a Leadership for the Government Executive Alum.

  
     
Application Completed By
 

Please provide the following information to allow us to follow up if there are any questions.*
Nominee's Sponsor (please go on to the next section).
Nominee's Manager (please go on to the next section).
Other - please fill out the information below

 
 
First Name   Last Name
*   *
 
  Working Title
*		  
  Telephone
*		  
  Email
*		  
     
Cohort Information
 

Please review the dates below and select the preferred cohort. *
If this nominee is selected, we will make every effort to put them in the cohort indicated below, however, we are not able to guarantee a place in any cohort. Cohorts are select to reflect a balance in many areas including IT/Programming, gender, department, etc.

  Cohort 5 (All Fridays)
Nov. 2, 2007
Dec. 7, 2007
Jan. 11, 2008
Feb. 1, 2008
Mar. 7, 2008
Apr. 4, 2008
May 2, 2008
Jun. 6, 2008
     
  Cohort 6 (All Fridays)
Nov. 2, 2007
Dec. 14, 2007
Jan. 18, 2008
Feb. 8, 2008
Mar. 14, 2008
Apr. 11, 2008
May 9, 2008
Jun. 6, 2008
 
     
Course Information
 
Course Code Course Title Start Date Price
08R LGE 601 05 Leadership for the Government Executive 11/2/2007 $3,964
 
     
By submitting this nomination, I understand that I am committing the nominee's time and effort for all seven sessions of the program.

I further understand that this nomination is not valid until the Registration Agreement has been received by the College of Continuing Education.

Click here to acknowledge that you agree to the terms of this nomination.

If you have questions, please contact:
Sherene Sasser
Program Manager
916-278-4297
sassers@csus.edu		 OR Ondria Small
Senior Program Coordinator
916-278-5315
smallo@csus.edu