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

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    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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    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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    Download as PDF, TXT or read online from Scribd
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    222 views2 pages

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

    Uploaded 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.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    SENATOR PATTY RITCHIE

    2013 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:
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________

    Past & Present Community/Civic Involvement:


    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    Volunteer Service:
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    Military Service:_____________________________________________________________________________________
    Present Occupation:__________________________________________________________________________________
    Relevant Past Occupations:____________________________________________________________________________
    Hobbies and Interests:________________________________________________________________________________
    Marital Status:______________________________________Children:_________________________________________
    Who or what were your nominees major influences?
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    What, if any, obstacles has your nominee overcome?
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    What do you think has been your nominees major accomplishment (s)?
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    ***Please email form to ritchie@nysenate.gov or fax to (315) 782-6357***

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