ATHENA Organizational 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 organization encourages women employees to achieve their full leadership potential.

II. Community Leadership

Provide specific examples of how the organization provides or supports leadership development opportunities and initiatives for women and/or girls in their community.

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 aspiring women leaders.