Women of Excellence Awards 2015
Nomination Form
SECTION I - Identify yourself and your Woman of Excellence:
Name of your
Woman of
Excellence
Your Name
Her address –
street #, street, city,
postal code
Your address – street
#, street, city, postal
code
Her email address
Your email address
Her phone #
Your phone #
SECTION II - Identify the category where you believe your Woman of Excellence has made her
biggest contribution to Brantford/Brant County/SixNations, or beyond (regionally, nationally
or internationally).
Please indicate with a check mark the category that best describes your Woman of Excellence. If more than
one category applies, please choose the most appropriate category. Each woman is restricted to one
category. It is up to the discretion of the Women of Excellence Selection Committee to make the final
determination as to the category best suited for your candidate.
Arts, Culture and Heritage: demonstrates outstanding achievement in the
expression, development, preservation, patronage and/or promotion of the
performing, visual, literary or multi-media arts and/or cultural heritage.
Active Living and Wellness: actively participates in or coaches sports, athletics,
fitness and/or recreation or promotes and helps others to achieve mental, physical
or spiritual well-being.
Business, Professions and Trades: provides visionary leadership and consistent
commitment to excellence; facilitates change and creates opportunities either in the
profit or non-profit sectors.
Agriculture, Environment, Science and Technology: provides noteworthy
direction and demonstrates commitment to innovative and sustainable practices in
agriculture, environment, science or technology.
Community Service: enriches our community and our society through her efforts;
harnesses the time, talent and capacity of others and is recognized as a source of
strength and heart in the community.
SECTION III: Answer 5 questions about your Woman of Excellence:
Please answer the following questions/requests in a maximum of 100 words per question. You may use point
form if you prefer, and may answer these questions in the space provided or on a separate sheet of paper.
a) How has your Woman of Excellence demonstrated
achievement and commitment in the category you
indicated in Section II? How has she made an important
contribution of lasting impact? (Give examples)
b) What qualities make your Woman of Excellence stand
out in the community? Please include how these attributes
make a difference.
c) Please list 2 people or organizations and their contact
information who you think will provide a reference for your
Woman of Excellence.
d) How has your Woman of Excellence inspired others?
How is she a leader, mentor, team builder or coach? (Give
examples)
e) Is there anything else you would like to add?
SECTION IV:
Have you advised your woman of excellence that you have nominated her? YES________
NO__________
Thank you for submitting your Women of Excellence form. Please send your completed form to
Women of Excellence, 260 St. Paul Ave., P.O. Box 26028, Brantford, ON, N3R 7X4 or e-mail to
womenofexcellencebrant@gmail.com
Thank you to CFUW Brantford for managing the 2015 Women of Excellence awards in
Brantford/Brant County.