ATHENA Leadership Award® Nomination Form

Nominee

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

Company/Orgnization

Title/Position

Business/Organization Address

Street Address Address Line 2 City State ZIP Code

Work Phone

Business Email

Nominator

Name

First Last

Company/Organization

Business Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

I. Professional Leadership

Provide specific examples of how the nominee has demonstrated excellence, creativity and initiative in their business or profession.

II. Community Leadership

Provide specific examples of how the nominee provides valuable service to improve the quality of life for others in their community. Include type and length of service in civic and service organizations and initiatives.

III. Personal Leadership / Mentorship

Provide specific examples of how the nominee has actively assisted women in achieving their full leadership potential, and/or demonstrated support for their personal and professional advancement.

Additional information pertaining to the criteria

Include any additional information you feel is important for consideration of your nominee. Include awards, honors, publications, articles and/or testimonials that demonstrate service to their profession, community, and, most importantly, aspiring and established women leaders.