Instructions:

Please fill out and submit the form with the appropriate information. For help see below.

Date of Pick Three
Leader's Name
Successee Level 1	Readiness Level	Diversity Rating White African American Hispanic Asian/European Other	Portfolio Yes No	Development Plan Yes No	Coach / Mentor Name
Successee Level 2	Readiness Level	Diversity Rating White African American Hispanic Asian/European Other	Portfolio Yes No	Development Plan Yes No	Coach / Mentor Name
Successee Level 3	Readiness Level	Diversity Rating White African American Hispanic Asian/European Other	Portfolio Yes No	Development Plan Yes No	Coach / Mentor Name
Successee Level 4	Readiness Level	Diversity Rating White African American Hispanic Asian/European Other	Portfolio Yes No	Development Plan Yes No	Coach / Mentor Name
Successee Level 5	Readiness Level	Diversity Rating White African American Hispanic Asian/European Other	Portfolio Yes No	Development Plan Yes No	Coach / Mentor Name
Successee Level 6	Readiness Level	Diversity Rating White African American Hispanic Asian/European Other	Portfolio Yes No	Development Plan Yes No	Coach / Mentor Name

Help:

• Date: Enter the date of your pick three selection.
• Leader's Name: Enter your name.
• Level 1 Successee: Enter the name of the employee who is in or slated to be in an established formal success plan. This employee is ready for promotion now or within 1 year.
• Level 2 Successee: Enter the name of the employee who is high potential for development but is not in the formal success plan. This employee is ready for inclusion into formal succession plan within 1 year - promotion within 1-2 years.
• Level 3 Successee: Enter the name of the employee that has potential and will be watched for the next 3-5 years to determine if they should be moved to level 2 succession or higher.
• Readiness level: Enter the level in which the successee is ready for promotion (i.e. 1, 2, 3)
• Diversity Rating: Enter the appropriate selection (See Legend).



Diversity Legend
W = White
A = African American
H = Hispanic
E = Asian/Eastern
O = Other



• Portfolio:: Enter "Yes" or "No" whether or not the successee has a performance portfolio.
• Coach/Mentor Name: Enter the name of the Coach/Member. If there is no Coach/Mentor enter "None".
• Developmental Plan: Enter "Yes" or "No" whether or not the successee has a development plan.