Nominee's General Information

Name: *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Cell Phone Number

Email Address *

What company/organization(s) is the nominee affiliated with? *

Current Position: *

Was the nominee a Girl Scout or volunteer? *

No

Yes

If yes, please elaborate If yes, please elaborate

Have you previously nominated this person for the Women of Distinction award? *

No

Yes

If yes, what year If yes, what year

Check the category that best represents the nominee (May check more than one) *

Essay Questions

Respond to each question in no more than 500 words. We encourage you to work with your nominee in the nomination process.

1. Provide a biography of the nominee. Please include awards, recognitions, education, and accomplishments. *

0/500 words

2. In what way does the nominee exhibit the key roles of Girl Scouts: changemaker, visionary doer, thinker or leader in the community? *

0/500 words

3. In what ways has your nominee helped the community and made a difference in people's lives? *

0/500 words

4. What do you see as her accomplishments? (personal, professional, philanthropic, or community) *

0/500 words

Supporting Information

Feel free to provide other supporting documents, such as press or web stories and letters of support for your nominee.

Signature of person nominating: *

clear

Please note: If your nominee is not selected this year, the nomination will be filed for review for the following year's award. At that time, you may be asked to update the information provided.