SENATOR PATTY RITCHIE

2014 WOMEN OF DISTINCTION NOMINATION FORM
Name and Address of Nominee:
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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:_____________________________________________________________________
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Community, Civic or Business Awards and Recognitions:
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Past & Present Community/Civic Involvement:
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Volunteer Service:
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Military Service:_____________________________________________________________________________________
Present Occupation:__________________________________________________________________________________
Relevant Past Occupations:____________________________________________________________________________
Hobbies and Interests:________________________________________________________________________________
Marital Status:______________________________________Children:_________________________________________
Who or what were your nominee’s major influences?
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What, if any, obstacles has your nominee overcome?
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What do you think has been your nominee’s major accomplishment (s)?
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***Please email form to ritchie@nysenate.gov or fax to (315) 782-6357***

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