Reconocimiento Awards Nomination Form

Please read the eligibility criteria and the instructions for the nomination to the right, then complete this form and submit.

Step 1 of 2

50%

Category*
- Career Achievement
- Leadership Achievement
- Volunteer Service
- Young Latina Leader (9 th -12 th grade)
Nominee
Information about the person being nominated for the Reconocimiento Awards
Name of the Nominee *
FirstLast
Title|Company|School*
Nominee Mailing Address
Street AddressAddress Line 2CityStateZIP Code
Day Phone*
Evening Phone
Cell Phone
Email
Nominator
Information about the person submitting the nomination (You)
Name of the Nominator*
FirstLast
Relationship to Nominee*
Nominator Mailing Address
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Daytime Phone*
Evening Phone
Cell Phone
Email
References
Please provide the names of two individuals who may be called as references for the nominee
Reference Name (1)
FirstLast
Phone
Relationship to the Nominee
Reference Name (2)
FirstLast
Phone
Relationship to the Nominee

You can also send your nomination by mail. Download, print and fill out the nomination form and mail it to:

Latinas Unidas
c/o Ibero American Action League
817 E. Main Street
Rochester, NY 14605

Click here to download the nomination form in PDF format.

Thank you!

Deadline for Submissions

** Nomination must be received by September 17, 2012 **

Eligibility Criteria

* Nominee must reside within the seven county areas located in Monroe, Ontario, Wayne, Genesee, Orleans, Yates, and/or Livingston County.
* Latinas Unidas Board Members may not be nominated.
* Attributes supporting Latinas Unidas Mission to promote unity, cultural identity and presence of the Latina woman in the community.

Instructions

* Describe the nominee’s accomplishments and contributions in the nominating category.
* Share name(s) of activities engaged, time frame and extent of the nominee engagement in such.
* Describe how has the nominee’s efforts helped to significantly improve her own life and/or the lives of other women in the community.
* Provide as much information as possible. Providing supporting documentation such as resumes, publications, website information, and references as applicable are encouraged.
* If needed, send supporting documents by email as an attachment to reconocimiento@LatinasUnidas.org.

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