40 Under 40 Application – The Leadership Center for Excellence

Northern Virginia 40 Under 40 Application

Applications are due by February 8, 2021.

Criteria for honorees:

Live or work in Northern Virginia
Be under the age of 40 on the date of the event (March 26, 2021)
Demonstrate impact through leadership personally and/or professionally

Leadership Center for Excellence and Leadership Fairfax affiliation is not required.

Title

First Name

Nickname

Last Name

Contact Number

Date of Birth

Email Address

LinkedIn URL

Home Street Address

State

City

Zip Code

Please list your past and current leadership positions held:

Please list degrees conferred:

Please list awards and public recognition received:

Company/Organization Name:

Company Website

Professional Title:

Which sector do you place your organization?

Non-profit

Government

For-profit

Please describe the leadership impact you’ve had in the community through your professional and personal achievements. 500 word maximum.

Please tell your personal story, including any information you’d like to the selection committee to know that hasn’t been shared above. 500 word maximum.

Please write a personal and professional biography of no more than 150 words. If selected, this will be your published biography.

By submitting this application, if selected, you agree to participate in the 40 Under 40 awards event and provide a headshot.

Please enter your name as an electronic signature.

Northern Virginia 40 Under 40 Application

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