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The Lightkeeper Nomination Form

  INSTRUCTIONS


- Submission deadline is Friday, September 5, 2008, at 5 p.m.
- Nominations must be submitted using this form.
- Only information on the application will be judged. News articles, resumes, additional pages, or other supporting documents should not be submitted with this application.
- Complete the nomination form in as much detail as possible as judges will use only the information provided on this form as the criteria for judging.
- A copy of the nomination form will be given to the nominee in order to provide more details and to ensure accuracy.

CRITERIA


Recipients must meet each of the following criteria:

- Must be a male or female who has made significant contributions to the issues affecting women and/or girls through grassroots efforts.
- Must demonstrate that everyone has something to contribute. For example, nominees may have overcome adverse conditions or life situations that contribute to their ability to lead and their passion.
- Have not received much public recognition for work and/or volunteer efforts but put forth 100% in all areas of life.
- Can be any adult who is working, retired, staying at home, volunteering, etc.
- Must not have filed Chapter 7 or 11 bankruptcy or been subject to any civil or criminal investigations within the last three years.

JUDGING


- A selection committee of community leaders and out-of-town judges will review all nomination forms and select the recipient.

 THE LIGHTKEEPER NOMINATION FORM


Please complete the following information in as much detail as possible. *Remember, only the information provided on this form will be used to select finalists.



1. Date
2. Nominee's Name
3. Nominee's Company
4. Nominee's Title or Position
5. Nominee's Address
6. Nominee's City, State, Zip Code
7. Nominee's Email
8. Nominee's Phone Number
9. Nominee's Fax Number
10. Nominator's Name
11. Relationship to Nominee
12. Nominator's Company
13. Nominator's Title or Position
14. Nominator's Business Address
15. Nominator's City, State, Zip
16. Nominator's Email
17. Nominator's Phone Number
18. Nominator's Fax Number
19. TEACHING/MENTORING: Provide a detailed explanation of how this nominee has assisted in the advancement of women or girls through teaching or mentoring.
20. PERSONAL & PROFESSIONAL GROWTH: Present evidence that the nominee is making significant progress toward personal & professional growth by accepting additional responsibilities and making contributions to their volunteer role or work environment.
21. COMMUNITY IMPACT: Identify and describe how the nominee's outstanding personal acts have resulted in helping women or girls and influenced the community. (Community could include neighborhood, church, volunteer organizations, etc.)
22. LEADERSHIP QUALITIES: Present evidence and describe in detail the nominee's leadership qualities and initiative.
23. ADDITIONAL INFORMATION: Describe in detail any additional qualities or activities you feel should be taken into account when considering this nominee.
 
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