2005 Award Nomination Form - YWCA McLean County

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Apr 8, 2016 - 2016 Award Nomination Form ... Phone: Work Phone: ... ___ Business - Outstanding abilities and accomplishm
27th Annual 2016 Award Nomination For m Nominee: __________________________________________________________________________________________ Home Address: _____________________________________________________________________________________ City: _____________________________ State: _____ Zip: ______________ Phone: ___________________________ Business/Organization/Affiliation: ______________________________________________________________________ Title: ______________________________________________________________________________________________ Address: ___________________________________________________________________________________________ City: _____________________________ State: _____ Zip: ______________ Phone: ___________________________ Work Phone: _______________________________________________________________________________________ Please check only ONE category for consideration. If you are not certain, please contact YWCA. ___ Business - Outstanding abilities and accomplishments in agriculture or business as a business owner, entrepreneur, or mid to upper/executive management ___ Creative Arts & Entertainment - Excellence in the arts, whether in promoting, supporting, teaching, or performing ___ Education - Excellence as an administrator, board member, or educator ___ Professions - Outstanding performance in a field such as finance, government, health care, labor, law, or religion ___ Social Services - Accomplishments through direct assistance or advocacy that have contributed to improving the quality of life for people in McLean County ___ Volunteer Service - The Harriett F. Rust Community Service Award will be given to a woman who has made significant contributions as a volunteer to better McLean County. ___ Young Professionals - A young professional who is new to their career and making a difference (whether professionally or through community engagement, etc. Be creative!) Your nominee must be the age of 40 or under and in their field for five years or less.

INSTRUCTIONS FOR COMPLETING NOMINATION FORMS Women nominated in previous years may be nominated again. Forms may be reproduced as needed. 1.

Each nomination must be submitted on a separate form. Form is available at www.ywcamclean.org/womenofdistinction.

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DO NOT attach additional reference materials to the form.

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ALL nominees/nominators are responsible for making sure nominees have portraits taken at élan Studios by Friday, April 29, 2016. Please phone Barb Adelman at (309) 827-4494 to set up an appointment. There will be no sitting fee, as photos are the property of the photographer.

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With the nominee’s knowledge and approval, please submit the completed nomination form to: YWCA McLean County by Friday, April 8, 2016, before 5 p.m.

All nominees will be recognized and honored at the Women of Distinction awards dinner on May 17, 2016. Thank you for your efforts in acknowledging the distinctive women of McLean County. For additional information, please call YWCA McLean County at (309) 662-0461 or visit our website, www.ywcamclean.org/womenofdistinction.

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Nominee: _________________________

Answers must be limited to space provided.

1. Provide a brief bio of the nominee including educational background, career path, and personal journey. (600 words maximum)

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Nominee: _________________________

Answers must be limited to space provided.

2. Describe the nominee’s qualities of leadership. (400 words maximum)

3. How has the nominee demonstrated commitment to improving McLean County? Specifically, how has the nominee advanced the YWCA’s mission of eliminating racism and empowering women and promoting peace, justice, freedom and dignity for all? (The nominee is not required to have a partnership with the YWCA, but rather, worked community-wide.) (400 words maximum)

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Nominee: _________________________

Answers must be limited to space provided.

4. List any certificates, awards or other recognition given to the nominee in the last five years that would support endorsement as a Woman of Distinction. (250 words maximum)

5. Please provide any additional comments relevant to the nominee’s accomplishments. (little-known facts, unique hobbies, special interests, etc.) (250 words maximum)

CERTIFICATION I certify the information provided on this form is, to the best of my knowledge, accurate and current. Signature: _________________________________________________________________________________________ Title: ___________________________________ Company/Organization: ______________________________________ Address: ___________________________________________________________________________________________ City: _____________________________ State: _____ Zip: ______________ Phone: ___________________________

Please email, mail, or fax nomination form before 5 p.m. on Friday, April 8, 2016. YWCA McLean County Women of Distinction Awards 1201 N. Hershey Rd., Bloomington, IL 61704-3619 Phone: (309) 662-0461, Fax: (309) 662-4506 [email protected]