Lieutenant Governor Leadership Award Nomination Form

Kindly submit nominations by Friday, April 18, 2025.

Incomplete forms will not be accepted. To be eligible, students must be graduating seniors and live in Rhode Island.

Please contact Katia Lugo at Katia.Lugo@ltgov.ri.gov with any questions.

Nominee Information

First Name

Middle Name

Last Name

Please check here to verify that the above spelling is accurate and can be printed on the nominee's certificate if they receive an award.

School

If you do not see your school listed here, please email our office at the contact listed above.

Is this student a graduating senior?

Nominee Email

Nominee Phone Number

Address Line 1

Address Line 2

City/Town

State/Province

ZIP/Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Multiple email addresses may be separated by commas. Emails are only sent to cc and bcc addresses if a To email address is provided.

Parent/Guardian Phone Number

Hometown Newspaper(s) of Nominee (optional)

Our office will notify local papers of award recipients.

Nominee Award(s) and/or Extracurricular Activities (if applicable)

Why was this student nominated? Type your answer below or attach a file.

Please limit your response to 250 words or less.

Submit an Attachment (optional)

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Title

First Name

Last Name

Address Line 1

Address Line 2

City/Town

State/Province

ZIP/Postal Code

Nominator Email

Multiple email addresses may be separated by commas. Emails are only sent to cc and bcc addresses if a To email address is provided.

Nominator Phone Number

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