Please fill out the form below for each nominee to the 2024 Executive Leadership for Information Technology Excellence (ELITE) program. Participants will be invoiced upon their acceptance into ELITE. Nominee’s First Name Nominee’s Last Name Name on Your Name Tag? (first name or nickname): Salutation (Mr./Ms./Dr./Cpt./....) Title Agency/University Department Preferred Mailing Address Preferred Mailing Address City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP Code Work Phone (ex. 512-555-1212) Cell or Alternate Phone Email Address Separate multiple email addresses with commas. This nominee would be a great addition to the Executive Leadership for Information Technology Excellence Class because Nominator's Name Nominator's Phone (ex. 512-555-1212) Nominator's Email Address Separate multiple email addresses with commas. Nominator's Assistant's Name Nominator's Assistant's Phone (ex. 512-555-1212) Nominator's Assistant's Email Address Separate multiple email addresses with commas. Course Code Leave this field blank
