Rising Star 2017 Nomination Info Finish If you have any questions regarding the completion of this form, please contact Janet Crink at 336-373-7020 or email firstname.lastname@example.org About the Nominee * Nominee's Name * Street * City * State * Zip Code * Phone * Email * Employer or Organization of Nominee * Employer or Organization Contact * Position or Role What makes her a Rising Star? Choose the criteria that describes the nominee’s contribution to our community. Select all that apply. Criteria to Consider None Mentoring at work and/or in the community Trailblazing accomplishments Making a tangible difference in the lives of others Inspirational leadership Entrepreneurship Acts of generosity Acts of heroism Public policy innovation and development Demonstrated involvement in advancing women... Impact in the Community Describe the nominee’s impact in the community (300 words or less). Impact In the Community You have 300 words remaining. Major Achievements List and describe up to 3 of the nominee’s major achievements. (300 words or less) Achievements You have 300 words remaining. Tell Us The Story What inspired you to choose your nominee? Share the story or anecdote. The Story You have 300 words remaining. References Please provide two or three references for the nominee representatives to contact concerning the nominee's positive impact in the community. Reference 1 * Reference Name * Phone * Email Reference 2 Reference Name Phone Email Reference 3 Reference Name Phone Email Nominator Info * Your Name (nominator) * Phone * Email * Street * City * State * Zip Code Verify and Submit CAPTCHA Contests & Events promotion Support Local Sweepstakes Enter for a chance to win a gift card to a local business! promotion Mom & Me Photo Contest Enter your Mom & Me Photo for the chance to win a prize from our sponsor! promotion Support Local! Buy gift cards to support your local businesses.