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Please complete this form to the best of your ability. Personal testimonies and documented examples of leadership techniques and experiences are necessary and considered an important part of the nomination process. Please include them! Short stories, examples, testimonials...these all provide valuable context to the nomination!

THE ATHENA LEADERSHIP AWARD

Do you know someone that lives and breathes these ATHENA qualities?

1. Assists women in reaching their full leadership potential

2. Demonstrates excellence, creativity, and initiative in all that they do

3. Improves the quality of life for others

4. Clearly serves as a role model for women, both personally and professionally

* Nominee Name: enter the name of the individual you would like to nominate for the ATHENA Leadership Award.
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* Nominee Company & Title: enter the nominee's employer/company name & job title.
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* Nominee Address: enter the nominee's address.
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* Nominee Phone & Email: enter the nominee's phone number and email address.
0/250
* Nominator: enter the name of the person(s) completing this form.
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* Nominator: enter the telephone number and email of the person(s) completing this form.
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* Date of submission: enter today's date.
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* Assists women in reaching their full leadership potential: describe how the nominee has supported women in leadership. This is the place to elaborate! Talk about impacts on people working with the nominee, get personal, give specific examples, and use multiple sources.
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* Professional Accomplishments: describe how the nominee's career path. What one accomplishment is the nominee most proud?
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* Community Service: describe local, state, and national level participation, length of service, offices held in civic & service organizations, charitable activities, political pursuits, religious groups, etc.
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* Other memberships, achievements, awards, and publications: nominees may have been honored for their service to their profession, industry, or community. They also may have publications to their credit or articles published supporting their service to their profession. Please list awards or honors received which support this nomination.
0/500
* Additional information: is there anything else you would like us to know in evaluating this nominee for the ATHENA award?
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If you need to submit additional documentation, please email all documents to: nichole@mibarry.com.

Up to 5 additional supporting documents may be included with your nomination form.