Cincinnati Women’s Executive Forum (CWEF)

New Membership Recommendation

CWEF’s membership is committed to diversity of expertise, experience, industry, ethnicity and size of organization. The information gathered will help to enhance diversity in our organization. Please take a moment to answer the following questions:

Name / Title
Company / Phone
Address / Fax
Email
Report to (Name and Title)

Please indicate nominee’s functional specialty

Accounting/Finance / Information Technology / Sales
Advertising/Pub.Rel./Media/Marketing / Law / Security
Fundraising / Operations / Technical/Engineering
General Management / Purchasing/Supply Chain / Other (please list)
Human Resources / Research & Development

Please indicate their industry

Advertising/PR / Health Care / Retail
Construction / Insurance / Real Estate
Consulting/Professional Services / Law / Technology
Education / Manufacturing / Transportation
Financial Services / Media / Utility
Government / Nonprofit / Other (please list)
Organizational characteristics / Annual organizational revenue
Public / $5 to $50 million
Private / $50.1 to $500 million
Nonprofit / $500.1 million to $1billion
Greater than $1 billion
Number of employees
0 – 25 / 500 – 1,000
25 – 100 / 1,000 – 5,000
100 – 500 / More than 5,000

Why do you recommend this person for membership inCWEF?

Personal information (optional)

Age / Ethnicity
35 and under / American Indian/Alaskan
36-45 / Asian/Pacific Island
46-55 / African American
56-65 / Hispanic/Latin
66+ / Other

List current and past corporate, non-profit board and civic involvement (including offices held).

List awards and recognition they have received. *

List hobbies or personal interests. *

Anything else you would like to share. *

PLEASE INCLUDE THEIR CURRICULAVITAE OR PERSONAL BIO WITH YOUR APPLICATION SUBMISSION

Recommending Member’s Signature ______Date ______

*Please use more space as required to completely answer the question.

Privacy Policy

CWEF understands that some of the information you may be asked to provide to CWEF is confidential. CWEF will not disclose to any third party the information provided on this questionnaire. The Board and the Membership Committee will only use such information for internal CWEF purposes. Members will be asked from time to time to update information. CWEF will maintain only the most current information.

Rev.12/11