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NOMINATION FORM TWENTY-EIGHTH ANNUAL
MAINE WOMEN’S HALL OF FAME INDUCTION CEREMONY
MARCH 18, 2017
The MAINE WOMEN’S HALL OF FAME honors women who have made anoutstanding contribution to improving opportunities for all Maine women.
A woman may be nominated by an organization or an individual. It is the responsibility of the nominator to provide a complete nomination packet. All nominations must be submitted by December 1, 2016.
CRITERIA FOR NOMINATION – Each nominee must meet all of the following: (1) Woman’s achievement have had a significant statewide impact. (2) Woman’s achievement significantly improved the lives of women in Maine. (3) Woman’s contribution has enduring value for women.
REQUIRED FOR NOMINATION:(1) This completed nomination form with payment of $25 fee.(2) A statement defining how nominee has fulfilled all the criteria.
(limit of 300 words or two double spaced pages).(3) Supporting documents such as letters of recommendation, published articles, etc.(4) Nominee’s resume or curriculum vitae and list of accomplishments.
Sponsors will be notified as soon as judging is completed. Once final selections have been made, thenominee must agree to be present at the Induction Ceremony and must provide a photograph which willthen become the property of the Maine Women’s Hall of Fame. If the nominee is deceased, the sponsormust assume these responsibilities.
NOMINEE: Name ____________________________________________________________________
Address _________________________________________________________________________
City, State, Zip __________________________ Telephone ___________________________
SPONSORING ORGANIZATION OR INDIVIDUAL: Name ____________________________________________________________________________
Organization ________________________________________________________________
Address ____________________________________________________________________
City, State, Zip _________________________________________ Telephone ______________
Mail completed packet and a check for $25.00 payable to Maine Women’s Hall of Fame by December 1, 2016. To:Marilyn V. Ladd, 103 County Road, Oakland, ME 04963. For further information, call Marilyn Ladd at 207-873-0313 or email [email protected].