Pine Manor College
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The Center for ilsr

The Center for ilsr
617-731-7620
inclusive@pmc.edu

Whitney Retallic
Director
617-731-7620
retalliw@pmc.edu

Jennifer Ward
Assistant Director of Youth Outreach and Leadership Programs
617-731-7062
wardjennifer@pmc.edu

Carol Axelrod
ACCESS Coalition Coordinator
617-731-7691
axelrodcarol@pmc.edu

Tasia Cerezo
MACC AmeriCorps*VISTA
cerezotasia@pmc.edu

High School Leadership Conference

Guidance Counselor Nomination Form

I wish to nominate the following student for the upcoming Leadership Conference.
(You may reproduce this form if you wish to nominate more than one young woman.)

*Required Information
Student Information
*Student's Name:  
*Address:  
*City:  
*State:    *Zip:  
Phone:
E-Mail:
*Graduation Year:  
Guidance Counselor Information
*Name:  
*Position/Title:  
*School:  
School Address:
City:
State:   Zip:
*Phone Number:  

 
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