Nomination Information Form

Connectional Lay Council African Methodist Episcopal Zion Church

Eleventh Quadrennial Convention Dr. Victor J. Tulane Servant-Leadership Award

Eligibility for Nomination: All nominees for the Dr. Victor J. Tulane Servant-Leadership Award must have been an active member of the Connectional Lay Council for a minimum of (4) four consecutive years prior to the convention and must provide evidence of significant accomplishments as a leader. Each must submit letters of recommendation from each of the following: Local Pastor, Presiding Elder, and Bishop of the area. Additional recommendations may be submitted from an elected local community official, class leader, district or conference Lay Council President.
Card carrying member of the Lay Council and attend meetings and/or functions at one or more levels on a consistent basis. (__ Yes or __ No) / Member of the Connectional Lay Council for a minimum of (4) four consecutive years? (__Yes or __ No)

(Please type or print)

(Check one)
__Mr. __Mrs. __Ms. __Dr. / Last Name / First Name / Middle Initial / __Sr., __Jr.
Street Address / Apt. # / City / State / Zip Code
Email address / Home Telephone # / Cellular # / Fax #
Local Church Name: / Pastor’ Name:
Street Address / City / State / Zip Code / Telephone #
1) Briefly describe nominee’s involvement as a lay leader in two out of the four categories noted below. 2) Briefly describe significant accomplishments that embrace mentoring, qualities of a servant- leader and General Conference legislation that improved the governance and privileges of lay members in The African Methodist Episcopal Zion Church. In addition, a double-sided one-page vitae may be attached to this nomination form.
1. List Servant-leadership positions in The African Methodist Episcopal Zion Church: (Include tenure)
2. List Servant-leadership positions in Civic Organizations: (Include tenure)
3., Briefly describe the nominee’s valiant tenure in the U.S. Military Service:
4. Briefly describe nominee’s role and contributions as a vital administrator, member of the faculty or Staff in a college or university: (Include Tenure)
Note significant accomplishments that embraced mentoring; exhibited qualities of a servant- leader (servant first….leader second) and General Conference legislation that improved the governance and privileges of lay members in The African Methodist Episcopal Zion Church.

(Print) Submitted by: ______

Telephone # ______Email ______

It is the responsibility of the nominator to submit the Nominee Form to the CLC Office on or before the scheduled submission date of May 15, 2017. Forms not submitted on time may be disqualified.