Nominee Name

Title or position

Company

Business Address

City, State, ZIP Code

Business Phone

E-mail

1. ASSISTS WOMEN IN REACHING THEIR FULL LEADERSHIP POTENTIAL:

Provide specific examples of how the nominee has demonstrated support for the advancement and leadership development of business and professional women. (500 words or less)

2. BUSINESS ACCOMPLISHMENTS:

List special recognitions, projects, and achievements of the nominee. Include business-related affiliations, directorships, trusteeships or other designations. (500 words or less)

3. COMMUNITY SERVICE:

4. OTHER MEMBERSHIPS, ACHIEVEMENTS, AWARDS, PUBLICATIONS:

The nominee may have already been honored for service to their profession, industry or community. They may also have publications to her credit or articles published supporting her service to her profession, industry or community. Please list awards and honors received by the nominee that you are aware of which support this nomination. (500 words or less)

5. ADDITONAL INFORMATION PERTAINING TO CRITERIA:

Discuss briefly any additional factors you feel are important for consideration of  your nominee for the ATHENA Award. (500 words or less)

Nominator Information

Name:

Phone Number:

E-mail Address: