Helena Devereux Women In Leadership Award

NOMINATION FORM

Instructions: Complete Parts I, II, III, and IV

Deadline: Nomination Forms must be returned by Friday, May 15, 2015 to

Helena Devereux Women in Leadership, The Main Line Chamber of Commerce,

175 Strafford Ave., Ste.130, Wayne, PA 19087

or email completed form to

The nomination form must be completed in its entirety and curriculum vitae attached in order for nominee to be considered. Please print clearly. The form is also available online at www.mlcc.org.

Part I: Pertains to the Nominee and the Nominator.

NOMINEE
Nominee Name
Company / Title
Address / E-mail Address
Direct Phone / Company Web Site
NOMINATOR
Submitted By
Company / Title
Address / E-mail Address
Direct Phone / Company Web Site
Approval Signature of Nominator / Printed Signature of Nominator

Part II: Pertains to the Nominee’s accomplishments, achievements and service.

Please complete below. Attach additional information typed and double spaced.

Yes / No (Circle One): The Nominee's Company is a member of the Main Line Chamber

1.  List Nominee’s professional accomplishments, special recognitions, projects and achievements.

2.  List Nominee’s business and professional memberships, activities and any awards she has received.

Please include business-related affiliations, directorships, trusteeships or other designations.

3.  Describe Nominee’s impact on the local economy.

4.  Describe, in detail, the Nominee’s community-related achievements, activities and awards.

5.  Describe the Nominee’s support and commitment to all employees.
Give specific examples of how the Nominee has demonstrated such support for the advancement of the business and professional lives of all employees.

Part III: (250 words) Allows Nominator to impart personal information about the Nominee. Response should be descriptive and answer, in detail, why the candidate meets the criteria and should be considered as a finalist for the Helena Devereux Women In Leadership Award.

Part IV: Please attach Nominee’s curriculum vitae. In order for Nominee to be considered, the Nomination Form and Parts I, II, and III must be completed, and Nominee’s curriculum vitae attached.

Presented by The Main Line Chamber of Commerce and Devereux