2023 Women of Distinction Award Nomination Form

2023 Women of Distinction Nomination

YWCA Rock County invites you to participate in our Annual Women of Distinction Awards by nominating a woman, young woman (21and under) who has made a significant impact in our community and achieved personal & professional success.

About the Nominee
Nominee's Name*
Nominee's Address*
Street Address Address Line 2 City State ZIP Code
Nominee's Employer*
Nominee's Cell Phone*
Nominee's Email*
Tell us about yourself:
Nominator's Name*
Nominator's Address*
Street Address Address Line 2 City State ZIP Code
Nominator's Cell Phone*
Nominator's Email*
Please answer each of the following questions with 250 words or less. Submit this Nomination Form and other supporting materials or letters to the YWCA Rock County by 4PM, Monday, January 23, 2023. Letters of support: If your nominee has achieved success at work, at church, by assisting a nonprofit organization, etc., please submit letters of support. These help the selection committee get to know more about the nominee. Please provide no more than two letters of support.
1. What is your relationship to the nominee?*
2. Summarize your nominee’s accomplishments for use as an introduction to the nominee in publicity materials.*
Role Model: Describe how this person has served as a role model for others in her community or her profession.*
(Examples: How has the nominee influenced the lives of others? How has she helped women and girls achieve their goals? Is she a role model in her profession or in a volunteer capacity?)
Community Involvement: How has the nominee given back to the community through her time, talent, and/or resources?*
5. Achievements: How has the nominee demonstrated sustained excellence, accomplishment, and creativity in her profession? Please give specifics about how the nominee has garnered respect within Rock County or her professional field.*
6. Eliminating Racism & Empowering Women: How has the nominee shown that she actively supports the YWCA mission of eliminating racism and empowering women?*
(Examples: How has she proactively strengthened policies, practices, attitudes and/or actions that are creating equity for everyone? How is she involved in women’s issues? How has she worked to eliminate racism and make the Rock County community more inclusive and equitable?)
7. State any other reasons why this nominee should be recognized as a Woman of Distinction. (OPTIONAL)
Please upload supporting materials or letters that you believe will help the nomination committee make a decision.
Drop files here or

Max. file size: 2 MB.
Submit this Nomination Form and any other supporting materials or letters to the YWCA Rock County by 4 p.m., Monday, January 24, 2022. If your nominee has achieved success at work, at church, by assisting a nonprofit organization, etc., no more than two letters of support may be submitted. These help the selection committee get to know more about the nominee.

2023 Women of Distinction Award Nomination Form

2023 Women of Distinction Nomination

About the Nominee

Tell us about yourself: