Woman Volunteer of the Year Nominee
* denotes required information

NOMINATOR'S CONTACT INFORMATION
Organization Name:	*Contact Name:
Job Title:
Address Line 1:
Address Line 2:
City:	State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip/Postal Code:	*Phone:
*Email Address:
* denotes required information

NOMINEE'S CONTACT INFORMATION
*Name:
Address Line 1:
Address Line 2:
City:	State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip/Postal Code:	*Phone:
*Email Address:
* denotes required information

NOMINEE INFORMATION
1. Positions held in sponsoring organization and length of service:
2. Organizations for which your nominee has been an active volunteer with (leadership role, volunteer role) with a full description of her role and accomplishments:
3. List other awards received:
4. List three areas in which your nominee has made a significant impact on your organization (please elaborate):   5.What is the nominee’s greatest accomplishment as a volunteer?   6. What has touched your nominee the most as a volunteer?
Please upload the nominee's photo here (Optional)
max 4MB
Short resume of Candidate (or attach resume to form – optional):
max 4MB
8. Is there anything else we should know about your nominee?