Award Nomination Form - Woman Of The Year printable pdf download

Award Nomination Form - Woman Of The Year

The Woman of the Year awards are designed with an effort to publicly recognize exceptional

women within the Fifth Congressional District of California. Congressman Thompson welcomes

nominations of women from any individual or organization. All submitted nominations will be

thoroughly reviewed. The public recognition of the women, who have demonstrated leadership

in our community and have been able to make our community stronger, will be celebrated at a

special event.

Nominee Name:

Address:

Phone:

Email:

Nominated by:

Address:

Phone:

Email:

On a separate document, please answer the following:

 Describe your nominee’s achievement(s) in the community.

 List your nominee’s involvement in the community including the names of organizations

served, positions held and years of involvement.

 How has your nominee made visible impact in the community?

 Why do you think your nominee should be recognized? How has she inspired you?

Return your nomination to one of our district offices or via e-mail at

by February 26, 2017.

CA05.Nominations@mail.house.gov

Napa District Office

Santa Rosa District Office

Vallejo District Office

2721 Napa Valley Corporate Drive

2300 County Center Dr., Suite A100

985 Walnut Avenue

Napa, CA 94558

Santa Rosa, CA 95403

Vallejo, CA 94592

707/226-9898

707/542-7182

707/645-1888

707/251-9800 (fax)

707/542-2745 (fax)

707/645-1870 (fax)

Award Nomination Form - Woman Of The Year