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1. Nominee Information
(Note: Elected Officials and members of the Alameda County Commission on the Status of Women are not eligible)
Nominee Last Name:
***Last Name Required
Nominee First Name:
***First Name Required
DOB (optional):
Title:
Work affiliation (or high school for youth):
***Affiliation Required
Position:
Business/school address:(Do not use PO Box):
Street:
***Business/School Address Required
City:
***City Required
State:
***State Required
Zip Code:
Home address (Do not use PO Box):
Street:
City:
State:
Zip Code:
Business/school telephone:
Residence telephone:
Select the Supervisorial District you live or work in:
--Please Select--
District 1
District 2
District 3
District 4
District 5
Link to the District Lookup Webpage
Email address:
2. Nominator Information
Nominator Last Name:
***Last Name Required
Nominator First Name or Group Making Nomination:
***First Name or Group Required
Address (Do not use PO Box):
Street:
***Address Required
City:
***City Required
State:
***State Required
Zip Code:
Business telephone:
Residence telephone:
Email address:
***Nominator's Email Address Required
3. Category
Business & Professions
Environment
Philanthropy
Community Service
Health
Science, Technology and Engineering
Culture and Art
Justice
Sports and Athletics
Education
Non-Traditional Careers
Youth (11th and 12th grade females)
Emerging Leader
4. Questions
JUDGING CRITERIA BASED UPON RESPONSES TO QUESTIONS 1 - 3.
Please respond to the following questions and be specific.
Responses to each question must not exceed 250 words.
1. List experience in a volunteer and/or professional position worthy of a nomination relating to the selected category.
Note: you have entered
words. Responses to each question must not exceed 250 words.
2. Describe three (3) major achievements of the nominee. For example, include whether the nominee started a new program or used new methods to solve problems and/or initiate activities, whether the nominee accomplished desired results, and the impact or difference the nominee's achievements made in the community.
Note: you have entered
words. Responses to each question must not exceed 250 words.
3. Identify what distinguishes the nominee from her peers/collegues. For example, did the nominee have to overcome unusual challenges such as physical or mental handicaps, limited resources, public perception, etc...
Note: you have entered
words. Responses to each question must not exceed 250 words.
Submitted by:
***Submitted by Required
*
I certify this application has been completed to the best of my knowledge with complete and accurate information.