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Youth Empowerment & Mentorship

Celebrating Black Leaders Shaping the Next Generation

Description
Nomination Form

This category honors Black individuals in Washington State who dedicate themselves to uplifting, guiding, and equipping young people with the tools, confidence, and opportunities they need to thrive. Who Should You Nominate? Nominate someone who:

Leads programs, initiatives, or mentorship efforts that encourage personal, academic, or professional growth for youth
Creates safe and inclusive spaces where young people can develop leadership skills, explore talents, and build self-worth
Advocates for resources, rights, and opportunities that remove barriers for Black youth

What Makes a Nominee Stand Out?

A proven record of positive, lasting influence in the lives of young people
Measurable achievements such as improved academic performance, increased graduation rates, or successful career placements
Inspiring leadership that motivates youth to dream big and achieve more

Include in Your Nomination:

Details of the nominee’s role and involvement in youth-focused initiatives
Specific success stories or program results that highlight their impact
Support letters, testimonials, or statements from youth, parents, or community leaders

Complete the Nomination From

Nominee Information

Nominee Name

Nominee Email

Nominee Phone Number

Nominee Address

Nomination Category

Nomination Evaluation

Scoring Instructions:Please rate the nominee on each criterion using a scale of 1 to 5, where:

1 = Needs Improvement | 2 = Below Average | 3 = Average | 4 = Above Average | 5 = Exceptional

1. Impact & Reach

How significantly has the nominee influenced their community, field, or state? Consider depth and breadth of impact.

Please describe the nominee's influence and impact on their community, field, or state. Include specific examples of how their work has affected others and the scope of their influence.

Score (1-5)

2. Leadership & Initiative

Has the nominee demonstrated leadership, innovation, or initiative in their work or service?

Please describe the nominee's leadership and initiative

Score (1-5)

3. Alignment with Category

How well does the nominee's work align with the specific category's purpose and values?

Please describe how the nominee aligns with the selected category

Score (1-5)

4. Community Endorsement

Is there strong support or recognition from peers, community members, or organizations?

Please describe community support and recognition

Score (1-5)

5. Legacy & Sustainability

Does the nominee's work have lasting value or potential for continued impact?

Please describe the lasting impact and future value

Score (1-5)

Overall Evaluation

Additional Supporting Information
Any other relevant information that supports this nomination

Nominator Information

Your Name

Your Email

Your Phone Number

Your Relationship to Nominee

Additional Comments (optional)