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2013 New York State Senate "Women of Distinction" Nomination Form

2013 New York State Senate "Women of Distinction" Nomination Form

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Published by pritchie10
To nominate an individual for the New York State Senate's 2013 "Women of Distinction" program, please fill out this form and email to ritchie@nysenate.gov or fax to (315) 782-6357.
To nominate an individual for the New York State Senate's 2013 "Women of Distinction" program, please fill out this form and email to ritchie@nysenate.gov or fax to (315) 782-6357.

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Published by: pritchie10 on Jan 31, 2013
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01/31/2013

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SENATOR PATTY RITCHIE2013 WOMEN OF DISTINCTION NOMINATION FORM
Name and Address of Nominee: __________________________________________________________________________________________________ __________________________________________________________________________________________________Name of Nominating Individual:_________________________________________________________________________Organization and Title of Nominating Individual:____________________________________________________________ Address:___________________________________________________________________________________________Telephone:__________________________Fax:_________________________Email:______________________________Please provide the following nominee information:Birthdate:______________________________Place of Birth:_________________________________________________High School:_______________________________________College:__________________________________________Other Degrees and/or Certifications:_____________________________________________________________________ Academic Awards or Achievements:_____________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________Community, Civic or Business Awards and Recognitions: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

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