2024 Change Maker Nomination Form

Name of Nominee:*
Nominee Current Place of Employment (if appropriate:*
Nominee Title:*
Category*
- Arts, Entertainment, and Sports
- Business
- Education
- Government
- Healthcare
- Non-Profit and Faith
Please select one.
Nominee Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nominee Phone:*
Email*
Describe in 1500 characters or less why your nominee is a change maker?*
In 1000 characters or less, how did the nominee’s efforts result in a meaningful and measurable impact on others in Memphis?*
In 1000 characters or less, how is the Memphis change the nominee created sustainable?*
In 1000 characters or less, please describe how the nominee has inspired other Memphians to become Change Makers?*
In 1000 characters or less, How has the nominee demonstrated connectedness/collaboration in Memphis to achieve change?*
Your Name:*
Your Phone:*
Your Email:*

Leadership Memphis