Nomination Form - March of Dimes

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Heroines in Technology
Presented by Women in Technology and Benefiting the March of Dimes
Friday, November 14, 2008
Hyatt Regency Reston

Nominations Criteria and Form

Nominations Criteria:

Women must work in the technology field and exemplify volunteer service in the community. Individual nominees and corporate nominees must be located in the Washington, D.C., metropolitan area. Nominee must demonstrate achievement in spreading the mission and enhancing the success of the organizations with which she is involved. Nominee must agree to an interview and videotaping session (video will be presented at the event). Nominee must be able to attend the gala on November 14, 2008.

Nominations are due by Friday, August 1, 2008. All items marked with an * must be completed.

Nominee's Information

First Name *

Last Name*

Address 1 *

Address 2

City *

State *

Zip Code *

Email Address *

Company*

Title

Phone Number*:

Colleges Attended*:

Questions

Nominated By*:

	Self-Nominated
	Nominated By:Name

If you are nominating someone else, please provide your address and phone number:

Address:
Phone Number:

Nomination Category*:

	Individual: Individual nominees must be women who work in the technology field and exemplify volunteer service in the community (beyond participation within their company�s community outreach).

	Corporate: Corporate nominees must be a woman-owned or woman-run company that actively encourages employees to volunteer in the community.

Describe the nominee�s role and involvement in each non-profit, civic or fraternal organization with which they are involved.* (250 words or less for each organization)

How was each organization directly or indirectly impacted by the nominee�s volunteer service? What was the nominee�s impact to the organization?* (250 words or less for each organization)

Describe why the nominee should be considered a �heroine� in technology. Has the nominee used her talent, skills and knowledge to help the organization with which she is involved? If so, how?* (500 words or less)

If applicable, list the leadership roles or positions held by the nominee in each non-profit, civic or fraternal organization outside her primary place of employment. (For example, board of directors, event chair or committee chair.)

If applicable, list any awards or recognition that the nominee has received.

Please send one digital photographic headshot of the nominee to csolomita@marchofdimes.com (photo to be used in the event program).

Please send the nominee�s most current resume to csolomita@marchofdimes.com.

Optional: Send no more than three additional documents that further support the nominee�s involvement in the community to csolomita@marchofdimes.com. (For example, newspaper article, interview transcript, etc.)




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