Nomination for Female Goverment Leader

Name of Nominator:
Email address of Nominator:
Daytime phone number of Nominator:
Relationship to Nominee:

Name of Nominee:
Nominee's Title/Position:
Name of Government/Government Agency:
Nominee's Daytime Phone Number:
Nominee's Email Address:
Summarize the nominee’s success in her current position and in her career—citing specific accomplishments and achievements whenever possible:
Describe the nominee’s leadership qualities and traits—giving anecdotal examples of how they have been brought to bear to achieve a positive outcome for her government, community, or constituents:
How has the nominee been influential within her government and community and among her constituents?:
In what ways has the nominee inspired others—especially other women?:
Please include any other relevant information to support your nomination here: