FWLF Nomination Form

Nominator's Full Name

Nominator's Phone Number

Nominator's Email Address

Is the Nominee aware of the nomination? Is the Nominee aware of the nomination? Yes - Nominee is aware of the nomination No - Nominee is not aware of the nomination

Nominee's Name

Nominee's Phone Number

Nominee's Email

Company Name - If applicable

Title - If applicable

Second Reference for Nominee

Email of Second Reference

Phone of Second Reference

Does Nominee? (mark all that apply) Does Nominee? (mark all that apply) LIVE/LIVED IN FULLERTON WORK/WORKED IN FULLERTON VOLUNTEER/VOLUNTEERED IN FULLERTON ATTEND/ATTENDED SCHOOL IN FULLERTON

Describe how the Nominee has shown leadership and inspired others:

Describe how the Nominee has made a difference in Fullerton:

What additional factors make the Nominee deserving of the Women in Leadership Award, such as being a young up-and-coming leader, having a lifetime of achievement, showing business or non-profit leadership, etc.