FWLF Nomination Form

Date

Full Name

Phone

Email Address

IS YOUR NOMINEE AWARE OF THIS NOMINATION? IS YOUR NOMINEE AWARE OF THIS 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 person confiming nominations credentials

Phone of person confiming nominations credentials

Information that applies to nominee Information that applies to nominee LIVES/LIVED IN FULLERTON WORKS/WORKED IN FULLERTON VOLUNTEERS/VOLUNTEERED IN FULLERTON ATTENDS/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: