Nomination Form

Complete the Nomination form below and click the Submit button when finished. Upon acceptance to this program, the College of Continuing Education will send you a Registration Agreement which will need to be completed, signed and faxed to (916) 278-4865 in order for your nomination to be valid.

 

*Required Fields

 

Nominee
  Formal Name (this name will appear on formal documents, i.e., certificate)
 
 
 
 
 
 
 
 

 
 
 
 

   

 
 
 
 
   
   
 
 
 
 
 
 
 
     
Nominee Demographic Information
         
      
  Leadership for the Government Supervisor Alumni?: *  
  Leadership for the Government Manager Alumni?: *  
      
     
Position
 


 
 
 
 
 
 
 
   
Nominee's Manager
 
 
 
 
 

 
 

 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 

 
     
Nominee's Sponsor
   
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
   
     
Application Completed By
 


 
 
 
 
 
 
 
 
 
 
 
     
Short Answer Questions  

 

 
     
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 selected to reflect a balance in many areas including IT/Programming, gender, department, etc.

 

 
     
Course Information
Program Title Price
Leadership for the Government Executive $4,779
 
     
By submitting this nomination, I understand that I am committing the nominee's time and effort for all seven courses of the program.

I further understand that this nomination will be reviewed by committee. Upon acceptance, the nomination becomes valid when the Registration Agreement is received by the College of Continuing Education.

 

If you have questions, please contact:

 

Oksana Kolisa, Sr. Program Coordinator, 916-278-2981, kolisao@cce.csus.edu