2012 ATHENA Award Nomination Form

When nominating an individual for the ATHENA Award, we encourage you to retrieve the most accurate information possible to complete this form. You may contact the nominee if their guidance will help in completing this nomination. The judging committee selects the recipient based on the information provided in the nomination. Nominee Name________________________________________________ Title _____________________________ Company Name________________________________________ Email____________________________________ Address _______________________________________________________________________________________ Business Phone __________________________________ Home/Mobile Phone ____________________________ Nominated By____________________________________ Company/Title _________________________________ Email_________________________________________________ Phone___________________________________ Please complete the following information. This section may be completed by the nominator, nominee or a combination thereof. You may attach a photo of the nominee. (Please feel free to submit additional pages, if necessary.) 1. DEMONSTRATES SUPPORT OF PROFESSIONAL WOMEN:
Provide examples of how the nominee has demonstrated support for the advancement of business and professional women.

2. BUSINESS ACCOMPLISHMENTS:
List special recognitions, projects and achievements. Include business-related affiliations, directorships, trusteeships or other designations.

3. COMMUNITY SERVICE:

Describe local, county and state level participation, length of service and offices held in civic and service organizations, charitable activities, political pursuits, religious groups, chambers of commerce, merchants associations, etc.

4. OTHER MEMBERSHIPS, ACHIEVEMENTS, AWARDS, PUBLICATIONS, ETC.:

Please list awards and honors received that support this nomination:

5. ADDITIONAL INFORMATION PERTAINING TO CRITERIA:

Discuss briefly any additional factors you feel are important for consideration of your nominee for the ATHENA Award.

Please direct any questions regarding the nomination process to Michelle Rahl, Director of Marketing & Events. Completed nominations can be mailed to 500 E. Michigan Ave., Ste. 200, Lansing MI 48912, faxed to 517.484.6910 or emailed to mrahl@lansingchamber.org. All nominations must be received by 5 p.m. on Wednesday, August 31, 2012.