Women of Achievement Award Nomination 2012

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The Women of Achievement Awards program is designed to recognize and honor women who have already provided or aspire to provide significant contributions in their professional roles or in the community. This is evidenced by:
- Sustained record of accomplishments and contributions in her field
- Contributions to addressing significant issues
- Positive influence in the community
- The application of creativity or innovation in solving problems or overcoming challenges

Please consider nominating a deserving woman(en) for this prestigious award. On Thursday, April 19, 2012, the Women's Leadership Network (WLN) will host a recognition event at which nominees and sponsor companies will be recognized.

Women do not need to be a member of WLN to be nominated. WLN's current president, president-elect and past recipients are not eligible. Past recipients are under the 'Women of Achievement' section of the WLN Web site at www.dubuquewln.org.

Awards may be given to one or more women in each of the categories below at the discretion of the Nomination Committee. In the spirit of fairness, all names and workplaces will be removed for the Nomination Committee.

Deadline for submission: Friday, March 23, 2012, 5 p.m.

* = Denotes required field

Please select one or more categories for your nominee based on the category definitions below. The Selection Committe reserves the right to consider nominees in additional categories.
Achievements in Her Field Organizational Impact Growth & Accomplishments in Personal Life Service & Support of Non-Profit Work Unsung Champion Up and Coming Leader
Your nominee's information

So that we may alert the candidate about her nomination, please complete all fields.
Name of Nominee * First Last
Job Title (if applicable)
Employer (if applicable)
Home or Work Address? *
Work Home
Address of Nominee *
City *
State *
Zip Code *
Must be between 5 and 10 digits. Currently Used: 0 digits.
Email *
Tell us about her employer

If applicable, please provide the nominee's manager and CEO/President's name. We will send them an invitation to the awards ceremony.
Manager's Name * First Last
Manager's Address if different than above *
CEO/President's Name * First Last
CEO/President's Address if different than above *
Currently not employed
Tell us about your nominee

This nomination form is the only tool the Nomination Committee will use when choosing the award receipients. Therefore, it is important to answer all questions thoroughly. Please avoid using her name. If it is used, it will be blocked out before the committee receives the nomination.
Describe your nominee's career path/history. *
Maximum Allowed: 500 words. Currently Used: 0 words.
How has your nominee been a person of influence? *
Maximum Allowed: 500 words. Currently Used: 0 words.
Category Questions

Please answer the additional questions ONLY for the CATEGORY(IES) you are submitting your nominee.
Achievements in Her Field

Describe how the nominee's accomplishments go beyond a single organization and contribute favorably to an industry or profession.
Maximum Allowed: 500 words. Currently Used: 0 words.
Organizational Impact

Describe the nominee's efforts and achievements within her place of employment that have signficantly impacted the quality or enhanced the performance of her organization.
Maximum Allowed: 500 words. Currently Used: 0 words.
Growth & Accomplishments in Personal Life

Describe the nominee's accomplishments and/or obstacles that have signficantly enhanced the candidate's personal life.
Maximum Allowed: 500 words. Currently Used: 0 words.
Service & Support of Non-Profit Work

Describe the nominee's contributions of time and effort within her non-profit place of employment or through personal volunteer efforts in her community.
Maximum Allowed: 500 words. Currently Used: 0 words.
Unsung Champion

Describe this behind-the-scenes nominee that without her efforts, her organization could not have succeeded.
Maximum Allowed: 500 words. Currently Used: 0 words.
Up and Coming Leader

Describe this young leader, typically between the ages of 21 and 40, who is demonstrating dynamic leadership ability within her organization or her community.
Maximum Allowed: 500 words. Currently Used: 0 words.
Additional comments

If you wish to add additional comments about why your candidate should be considered for a Woman of Achievement Award, please do so below.
Maximum Allowed: 500 words. Currently Used: 0 words.
Nomination Submitted By * First Last
Please indicate the primary nominator here. See below to add any co-nominators.
Your Relationship to the Nominee *
Address *
City *
State *
Zip Code *
Must be between 5 and 11 digits. Currently Used: 0 digits.
Email *
Please list any co-nominators here.
Do you wish for the nominator names to remain anonymous to the nominee? *
Yes No
If my nominee is selected, I give permission for a portion of my nomination essay to be shared from the podium on awards night. *
Yes No
Nomination form deadline is 5 p.m. on Friday, March 23, 2012. Questions about the nomination process? Contact either:

Lynne Hager, Chair, Women of Achievement, at 563.582.1841 x270 or lhager@americantrust.com

Chelsea Ellingson, Co-Chair, Women of Achievement, at 563.690.4500 or cellingson@grandrivercenter.com
Do Not Fill This Out

Women's Leadership Network

Your nominee's information

Tell us about her employer

Tell us about your nominee

Category Questions

Achievements in Her Field

Organizational Impact

Growth & Accomplishments in Personal Life

Service & Support of Non-Profit Work

Unsung Champion

Up and Coming Leader

Additional comments