Women of Achievement Nomination Form 2017

Thank you for taking the time to nominate a deserving woman in our community. Please be sure to have enough time to complete this form since you are unable to save your changes and come back to this form at a later time.

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1. Enter your contact information.

Name: *

Your Relationship to Nominee: *

Address:

City: *

State: *

ZIP: *

Email Address: *

Phone Number: *

Please list any other co-nominators:

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2. Do you wish for your name to remain anonymous to the nominee?

Yes

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3. Enter your nominee's contact information.

Name: *

Company (if applicable):

Address: *

City: *

State: *

ZIP: *

Email Address: *

Phone Number:

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4. Tell us about her employer (if applicable) and we will send them an invitation to the awards ceremony.

Manager's Name:

Manager's Address (if different than above):

CEO/President's Name:

CEO/President's Address (if different than above):

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5. The nominations are gathered and given to a selection committee blindly (with no names) to choose two recipients from each award category. The selection committee is made up of community leaders both men and women who will diligently read each nomination and carefully consider your nominee. The recipients are selected based on the quality of nomination describing their efforts, not based on the number of nominations they have received.

Select a category or categories in which you would like nominate a deserving woman.

ACHIEVEMENTS IN HER FIELD - Accomplishment's go beyond a single organization and contribute favorably to an industry or profession.

ORGANIZATIONAL IMPACT - Efforts and achievements within her place of employment that have significantly impacted the quality or enhanced the performance of her organization

GROWTH AND ACCOMPLISHMENTS IN PERSONAL LIFE - Accomplishments and/or obstacles that have significantly enhanced the candidate's personal life.

SERVICE AND SUPPORT OF NON-PROFIT WORK - Contributions of time and effort within her non-profit place of employment or through personal volunteer efforts in her community.

UNSUNG CHAMPION - A behind-the-scenes woman that without her efforts, her organization could not have succeeded.

UP & COMING LEADER - A young leader who is demonstrating dynamic leadership ability within her organization or her community.

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6. Describe for the selection committee your nominee and why your nominee should be the recipient of the category or categories you selected in question 5.

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7. If my nominee is selected, I give permission for a portion of my nomination essay to be shared from the podium on awards night.

Yes

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8. How did you hear about the Women of Achievement Awards and how to nominate someone?

Women's Leadership Network luncheon

Women's Leadership Network newsletter

Telegraph Herald

Business Times

Dubuque 365

Radio

E-Mail

Other (please specify)