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Participation in the

Honorary Doctoral Leadership Program

at Ekklesia Institute Inc™ is

BY NOMINATION ONLY.

Ekklesia Honorary Leadership Program Nomination Form

The Honorary Doctoral Leadership Program at Ekklesia Institute Inc™ recognizes individuals who have demonstrated exceptional leadership, service, and impact in their profession or community.

Participation is by nomination only, ensuring candidates meet the leadership standards and institutional values of the Institute. All nominations undergo a formal review process, and nomination does not guarantee acceptance or conferral.

Nominator Full Name *

Nominator Phone *

Nominator Email *

Relationship to Nominee *

Nominee Full Name *

Nominee Phone *

Nominee Email *

Primary Area of Impact *

Why are you nominating this individual? What stood out to you about their work or character? *

What specific accomplishments, leadership behaviors, or community impact has this nominee demonstrated? *

How has this individual demonstrated excellence, integrity, consistency, or transformational service in their role or community? *

Explain why you believe this candidate deserves to receive this prestigious award, including how their work reflects excellence, integrity, and meaningful impact. *

I confirm that the information provided in this nomination is accurate to the best of my knowledge. *

Yes, I confirm.

I understand that all fees are subject to change, will incur a processing and are current for 2026.

Yes, I Understand.

I understand that, if the nominee is invited to continue beyond this pre-screening form, a non-refundable $125 application fee is required to proceed with the full nomination process. I further acknowledge that additional costs apply if the nominee is approved for honorary doctoral conferral, including but not limited to administrative, ceremonial, and institutional processing fees, which will be disclosed prior to final acceptance. *

Yes, I Understand.

I acknowledge that this is a pre-qualification submission only and does not guarantee selection, conferral, or invitation to complete the full application. All honorary recognitions are subject to institutional review, governance approval, and formal process.•

Yes, I Acknowledge.

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