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About
Program Areas
Engage
Events | Workshop | Conference
Scholarships
Careers
Contact

Contact Support Team
Membership Application Form
Volunteer Assignment Form
Non-Disclosure Agreement
Start A Chapter
Family & Community Support

Nominator Or Nominee Submission Form

NOMINATE OR NOMINEE SUBMISSION FORM

Date *

Date

Time

I am the: *

Nominator (Nominating Someone)
Nominee (Being Nominated)

Nominated By *

For Chieftaincy Title in This Kingdom: *

Nominator's Information

Nominator's Full Name (Person Nominating Someone) *

First

Last

Nominator's Phone Number *

Nominator's Email *

Nominee Information

Nominee Notification: I have notified the nominee and informed him or her of this nomination and requested that he or she expect to be contacted by WEN if selected *

Yes
No

Nominee's Full Name *

First

Last

Nominee's Phone Number *

Nominee's Email *

Nominee's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Nominee's Gender *

Male
Female

Nominee's Range *

Youth 19-29
Young Adult 30-39
Middle Aged Adult 40 – 59
Mature Adults 60 – 100

Nominee's Citizenship Status *

U.S Citizen
Resident
Non-immigrant
Undocumented

Nominee's Employment *

Full-Time
Full-Time
Self-Employed
Unemployed
Retired
Disabled

Nominee's Ethnicity *

Asian America
Black or African American
Hispanic
Latino
Middle Eastern American
Native American
Native Hawaiian
Pacific Islander
White
Other

Nominee's Marital Status *

Single
Married
Divorced
Widowed
Separated
Registered partnership

Does Nominee Have Children? *

Yes
No

How Many Children Does Nominee Have? *

Nominee's Spouse/Partner Name *

First

Last

Why Are You Nominating Person? *

Do you have any of these? *

Outstanding Misdemeanor Records
Outstanding Felony Records
Expunged criminal record
None of the above

Why Are Interested in Being Nominated to Receive a Chieftaincy Title? *

Nominee's Short Bio *

About Us

World Ebony Network (WEN) is dedicated to reinforcing the enduring and noble philosophies, principles, practices (3Ps) of our fore fathers and appreciating the good aspects of other heritages. Our mission helps us to achieve our 3 part vision: to plead the socio-economic causes of people of African ancestry; to reconcile the estrange cultural relationships of people of African ancestry; and to appreciate the good aspects of other heritages.

Resource Links

Contact Support Team
Membership Application Form
Volunteer Assignment Form
Non-Disclosure Agreement
Start A Chapter
Family & Community Support

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