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NOMINEE INFORMATION:
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Name of Nominee:
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Date of Birth (optional):
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Work Affiliation (or High School for Youth):
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Position:
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Business/School Address (with Zip Code):
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Business/School Telephone (with Area Code)
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Home Address (with Zip Code):
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Residence Telephone (with Area Code):
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Email:
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NOMINATOR INFORMATION:
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Name of Person(s) or Group Making Nomination:
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Business Telephone (with Area Code):
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Residence Telephone (with Area Code):
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Mailing Address (with Zip Code):
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Email Address:
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Name of Person Completing This Form:
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Today's Date:
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CATEGORY OF NOMINATION (please check one):
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Business and Professions
Community Service
Culture and Art
Education
Environment
Health
Justice
Science
Sports and Athletics
Youth
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JUDGING CRITERIA:
Please include a nomination statement addressing these questions:
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1. List experience in volunteer and/or professional position relating
to the selected category above.
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2. Describe three (3) major achievements by Nominee. Include the following
(below):
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a. Was Nominee active, founder, and not figurehead?
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b. Did Nominee start a new program, use new methods to solve problems,
and/or initiate activities?
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c. Did Nominee accomplish desired results?
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d. Describe the impact or difference the Nominee's achievement made
in the community.
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3. What distinguishes the Nominee from her peers/colleagues? For example,
did the Nominee have to overcome unusual challenges, such as physical
or mental handicaps, limited resources, public perception, etc.?
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Click SUBMIT (below) to send your nomination.
OR
Print out and mail to:
Commission on the Status of Women
24100 Amador Street, 6th Floor
Hayward, CA 94544
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