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2023 Influential Women Official Nomination Form
Nominations are due by Sept. 28th, 2023. Judges select winners based on merit, not number of nominations. Nominating someone multiple times will not improve their odds of being selected. Incomplete nomination forms will not be considered.
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1.
Nominee Contact Information
(Required.)
Name
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Company
*
Address
Address 2
City
State
ZIP
Email Address
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Phone Number
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2.
Job Title
(Required.)
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3.
Field (i.e. Healthcare, STEM, Arts, etc.)
(Required.)
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4.
County
(Required.)
Adams
Allen
Defiance
DeKalb
Elkhart
Huntington
LaGrange
Noble
Paulding
Steuben
Van Wert
Wabash
Wells
Whitley
Williams
5.
Career Based Achievements:
(Please provide as much information about the nominee's work history and career achievements for consideration. It's okay if you don't have all the details, but please be specific. Judges will use this information when deciding who to award. )
6.
Community Based Achievements
(Please provide information about the nominee's work in the community or professional organizations. Explain how he or she makes a difference. It's okay if you don't have all the details, but please be specific. Judges will use this information when deciding who to award.)
7.
Anything else the judges should know:
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8.
Nominator Contact Information
(Required.)
Name
*
Company
*
Address
Address 2
City
State
ZIP
Email Address
*
Phone Number
*
*
9.
Relationship to nominee (Spouse, coworker, boss, etc.)
(Required.)
