12th Annual Bethune Leadership Recognition Banquet Nominee Application

Congratulations Nominee!

The Valdosta–Lowndes Metro Section of the National Council of Negro Women (NCNW) is honored to present the:

12th Annual Bethune Leadership Recognition Banquet

This distinguished recognition program celebrates outstanding leaders who exemplify excellence through leadership, service, advocacy, scholarship, mentorship, and community impact.

Inspired by the enduring legacy of Dr. Mary McLeod Bethune, this program honors individuals who continue to uplift communities, empower others, and create meaningful change through service and leadership.

Join us as we celebrate vision, purpose, and transformational impact.

Event Information:

Saturday, November 7, 2026

Valdosta State University Student Union Ballroom

1500 N Oak St.

Valdosta, GA 31602

Application Submission Deadline

All applications and supporting materials must be submitted no later than:

September 30, 2026 at 11:59 PM

Incomplete applications may not be considered.

For questions or assistance, please contact:

ncnwofvaldosta@gmail.com

Instructions

Please carefully review the following requirements before submitting your application:

Complete all required sections of the application.
Upload one high-resolution headshot.
Upload two (2) letters of recommendation/reference.
Submit all required written responses.
Ensure all information is accurate and complete prior to submission.
Applications submitted after the deadline may not be accepted.

Nomination Category

What Level Nomination Are You Applying For?

Community Leadership (For individuals actively serving the community)

Collegiate Leadership (For college students demonstrating leadership, scholarship, and service.)

High School Leadership (For high school students demonstrating academic achievement, leadership, and community involvement.)

Nominee Information

Full Name

Preferred Name

Email Address

Phone Number

Multi-line address

Country/Region

Address

City

Zip / Postal code

Organization/School/Employer

Current Title/Grade Level

Facebook

Instagram

YouTube

Parent/Guardian Information

Parent/Guardian Name

Required for High School nominees only.

Parent/Guardian Phone

Required for High School nominees only.

Parent/Guardian Email

Required for High School nominees only.

Escort Information (Optional)

If requesting an escort arrangement, please provide:

Escort's Name (Optional)

Escort Contact Information

Note:

Nominees requiring an escort must submit a $50 payment to cover escort arrangements.

Supporting Documents

Headshot

Upload one professional high-resolution headshot suitable for banquet and recognition materials.

Upload a high-resolution headshot.

Letters of Recommendation

Upload two (2) letters of recommendation highlighting: -leadership -character -service -impact -professionalism -academic or community excellence

Upload two (2) letters of reference.

LEADERSHIP & ACHIEVEMENT QUESTIONS

Personal Statement & Leadership Journey

Tell us about your leadership journey, accomplishments, goals, values, and the experiences that have shaped your personal and professional growth.

Provide a strong introduction of who you are, your aspirations, accomplishments, leadership experiences, and the personal values that guide your service and impact.

Leadership Experience & Impact

Describe how you have demonstrated leadership and created positive change within your school, organization, workplace, or community.

Include leadership roles, initiatives, mentorship, advocacy, problem-solving experiences, or opportunities where you motivated others, influenced change, or made a meaningful impact.

Community Service & Engagement

Describe your involvement in community service, volunteerism, outreach initiatives, mentorship, advocacy, or civic engagement activities.

Highlight service activities, organizations, outreach programs, or volunteer efforts where you demonstrated care, commitment, and meaningful involvement within your community.

Commitment to Excellence

Share accomplishments, recognitions, milestones, or experiences that demonstrate your dedication, resilience, integrity, and pursuit of excellence.

Include academic, professional, entrepreneurial, leadership, or personal achievements that reflect your commitment to growth, reliability, discipline, and exceeding expectations.

Inspiration & Influence

Describe how your leadership, service, character, or personal example has inspired, empowered, encouraged, or positively influenced others.

Share examples of how you have served as a role model, motivated others, encouraged growth, or positively impacted peers, students, colleagues, family members, or your community.

Acknowledgment and Signature

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

By signing, I affirm that the information provided is accurate and truthful to the best of my knowledge.