Eliminating Racism Empowering Women

YWCA Mohawk Valley’s SALUTE to Outstanding Women 2012 Nomination Form

The YWCA Mohawk Valley will honor an outstanding woman from each of the categories listed below. An independent panel of judges has the responsibility of evaluating and selecting the award recipients. Selections are based solely on the information provided on this nomination form.

Eligibility: Nominees must live or work in Oneida or Herkimer County and must have demonstrated excellence and leadership in the workplace and/or the community.

How to Nominate: Please complete and submit the online nomination form below. Or print, complete and mail the form - Click here to download the nomination form in PDF format.

Salute to Outstanding Women Luncheon: Noon, Thursday, April 5th, 2012 at Hart’s Hill Inn.

Nomination Deadline: Thursday, February 2, 2012

Arts and Communications: Fine and performing arts, media, communications, entertainment, etc.	Human and Public Services: Public sector, non-profit employees, etc.
Business and Industry: Entrepreneurs, small and large business owners, employees, etc.	Professions: Attorneys, clergy, engineers, accountants, etc.
Education: Teachers, instructors, administrators, community educators, coaches, mentors, etc.	Racial Justice: Individualwho works to eliminate racism and promote diversity.
Health Care: Physicians, nurses, healthcare professionals, etc.	Unsung Heroine: Dedicated volunteers.

*Bold fields required

Nominee Information:

*Nomination Category: *** Choose A Category *** Arts and Communications Business and Industry Education Health Care Human and Public Services Professions Racial Justice Unsung Heroine

*First Name:

*Last Name:

*Co./Org.:

*Title:

Home Address:

City:

State:

Zip:

Home Phone:

Work Phone:

*Email Address:

Nominator Information:

*First Name:

*Last Name:

*Co./Org.:

*Title:

Mailing Address:

City:

State:

Zip:

Home Phone:

Work Phone:

*Email Address:

*A. How does this woman personify the YWCA’s mission of ‘eliminating racism and empowering women’?

*B. List her major responsibilities and scope of position in the workplace/community.

*C. What personal qualities/traits distinguish this woman, and what has been her impact to the community/workplace?

*D. What challenges has this woman overcome while trying to succeed?

*E. Add your personal supporting statements.