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Online Women of Influence Nomination

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Background:

The City of Fairfax Commission for Women is seeking nominations for the Women of Influence Award.  This is an opportunity to recognize and celebrate some of the outstanding women who live in the city and have made a significant impact on the lives of City residents.  An awards ceremony and reception will be held during Women’s History Month at the City Council meeting on March, 24, 2020 at the City Hall Annex, Room 100, 10455 Armstrong Street, Fairfax, VA 22030. The selection of awardee(s) will be based upon the information provided by the nominator on the nomination form.  We request that the nominator inform the nominee of the nomination.

Completed nomination packets must be submitted no later than Friday, February 28, 2020. 

Eligibility:

  • The nominee must be a resident of the City of Fairfax.
  • The work for which the nominee is being nominated must benefit residents of the City of Fairfax.
  • Elected officials or candidates for office are not eligible.
  • You may nominate a group of women (defined as two or more women) for an award.
  • You may nominate only one person/group per form; complete a separate form to submit a nomination for an additional person or group.
Please correct the field(s) marked in red below:

Nominee's Information:

Nominee's Name (Last, First):
 *
Job Title:
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Organization Name:
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Street Address:
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Phone Number:
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Phone Number:
Email Address:
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Why have you nominated this individual (or group)?
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Briefly describe the nominee’s community involvement, volunteer activities, programs, projects, and/or other efforts that influence the lives of women and/or girls:
 *
Biography of nominee (100 words or less):
 *
Additional information that is relevant to the application for the nominee, such as past awards, memberships on boards and commissions, and website links to stories and materials regarding the nominee’s background and work in the community:

Nominator’s Information

Nominator's Name (Last, First):
 *
In what capacity do you know the nominee?
 *
Phone number:
 *
Phone number:
Email address:
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Street Address:
 *
 
 *
If submitting a nomination on behalf of a company or organization:
Name of Company or Organization:
Company or Organization Website:
Street Address:
 
  1. To receive a copy of your submission, please fill out your email address below and submit.