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Tribute to Women (TWIN) Honoree Nomination Form
Application Deadline for Nomination is Wednesday November 25, 2009 by 5:00 pm

Instructions:
Before filling out this form, please read the Application Guidelines and Requirements.

Fill out this form with Nominee and Nominator information as requested.

We are sensitive to the privacy and security issues of any information submitted to us. Please read our privacy policy if you have any questions about our commitment to protecting your privacy and/or what the YWCA does with information you submit via this website.

Don't forget to print this form after you have filled it out, but before you submit the information using your browser's print function.

 

Nominee Information:
Please answer all of the following questions.
 
Nominee's Name:
   
 First Name  MI*  Last Name
  (*if used)
 

 Suffix		  
  Other
Company:
Position / Title:
Bus. Mailing Address1:
Bus. Mailing Address2:
City, State, Zip:
Business Phone:   Ext:   Fax:
E-mail:
Home Mailing Address:
Street Address / P.O. Box
 
City, State, Zip:
Home Phone:

Contact Person for Nominee:
Note: Admin. Asst./person responsible for follow-up details with Honoree.
Contact's Name:
   
 First Name  MI  Last Name
Position / Title:
Bus. Mailing Address1:
Bus. Mailing Address2:
City, State, Zip:
Business Phone:   Ext:   Fax:
E-mail:

Nominator:
Note: Must be CEO or highest-ranking local officer or director in company or division/business unit.
Nominator's Name:
   
 First Name  MI  Last Name
Position / Title:
Bus. Mailing Address1:
Bus. Mailing Address2:
City, State, Zip:
Business Phone:   Ext:   Fax:
E-mail:
  I acknowledge the requirement to host a table at the event to recognize the company's Honoree and to support the fundraising activities and mission of the YWCA of Silicon Valley. Please note that there is a minimum donation of $2,500 per honoree.

Sponsor Contact:
Note: Responsible for all follow-up details for corporate sponsorship.
Name:
   
 First Name  MI  Last Name
Position / Title:
Bus. Mailing Address1:
Bus. Mailing Address2:
City, State, Zip:
Business Phone:   Ext:   Fax:
E-mail:

Nominee Profile:
Please answer all of the following questions as they pertain to the nomination criteria described in the Application Guidelines and Requirements. The selection committee will rely on this information in making its decision for selecting the final TWIN Honorees.
 

1-a. Statement of achievement from Nominator in 200 words* or less:

  • Describe your nominee’s significant contribution to the company during the 2009 calendar year in regards to the impact on the organization relative to its growth, profitability and innovation
  • Describe how the nominee has a significant share of the organization's annual budget and/or executive level responsibility for financial performance of the organization
  • Explain what separates this nominee from others as a leader in the company
  • Discuss any outstanding leadership qualities that your nominee routinely demonstrates and specifically how this person is a successful role model for other women transitioning into executive positions or how this nominee mentors/coaches women internally or externally from the organization

*Note: This statement is the MOST IMPORTANT CRITERIA the Selection Committee will use during the selection process.
Statement of 
Achievement:
(200 words) 
1-b. Statement of achievement from Nominator in 50 words* or less:

*Note: THIS STATEMENT WILL BE PRINTED IN THE EVENT PROGRAM BOOK (may be an excerpt from the 200 word statement of achievement or additional statement).
Statement of 
Achievement:
(50 words) 
 
2. List the three most critical responsibilities of nominee:
 



 
3. Number of management levels between the CEO/highest-ranking local officer in the company or division/business unit and the nominee:
  1         2         3         4         5 or more
     
4. Nominee reports to:
Name:
Title:
     
5. Nominee's total years with company (The nominee must have been employed at current company for at least one year at time of nomination.):
  1-5 yrs.           6-10 yrs.           over 10 yrs.
6. Number total of local employees in the company:
  1-100             101-500             501-2,000
            2,001-10,000             greater than 10,000
 
7. Number of employees under nominee's management:
  0             1-10             11-20
            21-50             51-75             76-100
                        greater than 100
For Corporation,   or Division/business unit
 
8. Does the Honoree have global responsibility: Yes   No n/a
9. Percentage of total company budget nominee is responsible for:
  0-25%             26-50%             51-75%
            76-100%
For Corporation,   or Unit/Division
 
10. Nominee's total operating budget: (Optional)

Company Profile:
11. Company Name (as it should appear in all publicity):
 
12. Organizational Profile (provide a description of your company in 50 words or less):
NOTE: Item 12 (Profile) will be printed in the Event Program.
 
         
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