1. Is this nomination for yourself or for someone you know? If it is for yourself, don't be shy. We love to receive self-nominations!

2. What is the first name of the nominee?

3. What is the last name of the nominee?

4. What is the email address for the nominee?

5. What is the nominee's company / organization, title and type of industry / area of business?

6. How is this person disrupting professionally in business, entrepreneurship, social good, science, education, healthcare, creative arts, or politics? Are they creating growth, changing courses, developing new to the world ideas, products or services?

7. How is this person a positive role model to younger women? How are they innovating around work/life issues and promoting women for leadership whether in business, board rooms or building diverse communities?

8. How is this person disrupting themselves? Are they harnessing the power of their experiences and re-applying, re-assessing and creating a new path?

9. Please list any professional or personal websites, blog addresses? Or any additional relevant affiliations.

10. What is the nominee's LinkedIn address?

11. List any relevant social media links for the nominee (Twitter, Facebook, etc):

Thank you for your nomination! Here's a sample post if you want to share your nomination on Facebook or Twitter:

I just nominated PERSON'S NAME for Forty Women To Watch Over 40. Nominate someone who inspires you: http://fortyover40.com/nominate/ @fortyover40