ATHENA Nomination Form
ATHENA Nomination Form
ATHENA Nomination Form
Date___________________________
NOMINEE
Name_________________________________________________________________
Home
Address_______________________________________________________________
City _______________________________ State _______________ Zip Code_______
Telephone_________________________E-Mail______________________________
Company/Organization
Name_________________________________________________________________
Title/Position___________________________________________________________
Business
Address_______________________________________________________________
City ________________________________ State ______________ Zip Code_______
Work phone ____________________ Business E-Mail__________________________
NOMINATOR
Name_________________________________________________________________
Company/Organization
Name_________________________________________________________________
Business
Address______________________________________________________________
City_________________________________ State ____________Zip Code_________
Work phone _____________________________ Cell__________________________
E-Mail______________________________________
1.
Professional Leadership
Provide specific Examples of how the nominee has demonstrated excellence, creativity
and initiative in their business or profession
2.
Community Service
List local, state, national and international level participation. Include length of service
and offices held in civic and service organizations such as charitable activities, political
pursuits, religious groups, chambers of commerce, merchants associations, etc.
3.
Personal Leadership
Provide specific examples of how the nominee has assisted women in reaching their
full leadership potential, and/or demonstrated support for their professional
advancement.
4.