Before beginning this nomination form, please be sure you have read all of the requirements for nominations on the Moody on the Market website and that the woman being nominated not only lives or works in Berrien, Cass, or Van Buren Counties, but be certain she has not already won the honor in the past. Multiple entries for the same person will not be considered; only the first nomination received.

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* 1. First and Last Name of the Person You Are Nominating

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* 2. Nominee's Job Title

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* 3. Nominee's Place of Employment

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* 4. Street Address, City, State, Zip of Nominee's Place of Employment

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* 5. Nominee's Phone Number at Place of Employment

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* 6. Nominee's Cell Phone Number

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* 7. Nominee's Email Address

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* 8. Link to Nominee's LinkedIn or Facebook Profile

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* 9. Inc. Magazine defines 7 actions that make bold people admirable. Which of these are exhibited by the woman you are nominating?

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* 10. Of those seven actions of bold people, which is the most prevalent in the life and business of your nominee, and provide an example of how and why...

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* 11. Bold women are often defined by a number of descriptors. Which one of the following best describe the woman you are nominating? (Please select only one)

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* 12. Briefly explain why you chose that descriptor above using examples of how the nominee has exhibited that trait.

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* 13. Tell us about the nominee's career path and/or current position

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* 14. How has this nominee made an impact at her place of work or in her organization?

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* 15. How has this woman made a difference in and for the community of Michigan's Great Southwest?

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* 16. Tell us about the nominee's milestones, awards and/or other special recognitions...

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* 17. Any further comments about the nominee?

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* 18. Nominator, please tell us about who you are.

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* 19. Please tell us your relationship to the person you are nominating

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