MYL Seminar Nomination

To nominate a student, simply fill out the online form below, or click here to download the paper form which can be mailed in.

If you have any additional questions, please contact Jim Cox at 207-221-3196 or maineyouthleadership@gmail.com.

School Name

School Mailing Address

Principal's Name

First Name

Last Name

School's Phone Number

(###)

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Your Name

First Name

Last Name

Your Title

Your Phone Number

(###)

###

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Your Email Address

Nominee's Name

First Name

Last Name

Gender

Nominee's Home Address

Nominee's Email Address

Nominee's Phone Number

(###)

###

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Alternate Student's Name

First Name

Last Name

Gender

Alternate Student's Home Address

Alternate Student's Email Adress

Alternate Student's Phone Number

(###)

###

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Any Additional Notes