Nominate a Student

Please complete the form below to nominate a current college student who you believe would benefit from attending Leadership Iowa University. Self-nominations are also encouraged.

Please feel free to contact us at info@leadershipiowauniversity.com with any questions.

Nominee Information

First Name *

Last Name *

College/University *

Year in School *

School City *

School State *

Phone

E-mail *

Current Mailing Address*

Mailing Address Provided*

City *

State *

ZIP Code*

Nominator Information

I choose to self-nominate

Nominator First Name *

Nominator Last Name *

Organization *

Position/Title *

Relation to Nominee *

E-mail *

Phone

Address (line 1)

Address (line 2)

City

State

ZIP Code

Nominate a Student

Nominee Information

Nominator Information

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