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WIT Leadership Award 2010 Nomination Form
DEADLINE: March 3, 2010

Should you have any questions please call or email the Women in Technology office at 703.683.4003 or staff@womenintechnology.org.�

Please click here for more detail and criteria on each of the award categories.

Nominee: *

Company: *

Title: *

Phone: *

Email: *

Does this person know they are being nominated?� *

Yes

By checking the �Yes� box you grant WIT permission to contact the nominee directly.

Nominated by: *

Company: *

Title: *

Phone: *

Email: *

Please provide, Marketing, PR, or Administrative contact to assist in collecting information should this nominee be chosen as a finalist. (It can be the same person as the nominator, if they serve in the capacity.)

Additional Contact: *

Company:*

Title:*

Phone:*

Email:*

Nomination Category (please choose only one): *

	Corporate Commercial Small Business (Must be less than $100 million in annual revenue)
	Corporate Commercial Large Business
	Corporate Public Sector Small Business (Must be less than $100 million in annual revenue)
	Corporate Public Sector Large Business
	Entrepreneur
	Government
	Health IT
	Global Impact
	Unsung Hero
	Rising Star (Must have 10 years or less of work experience)
	WIT Champion

Please provide detailed answers to the following questions.� Each question will be weighed equally in the selection process. Note, please provide a detailed description with practical examples of the applicable attributes for your nominee.� Your nomination document should not be a resume.

1. Connect: *

Please detail how the nominee is an exemplary role model/mentor. How has she used her leadership skills to act as a mentor for others? How has she helped to develop future leaders in her profession and /or community? Maximum 1650 characters (200 words).

1650 characters remaining for the connect

2. Lead: *

Please detail the nominee�s leadership achievements and style. How has she demonstrated an ability to create a vision for her teams? How has she motivated and mentored employees and team members? What achievements would qualify as �pioneering� efforts? In what way has she been an architect of change in the technology community? Maximum 1650 characters (200 words).

1650 characters remaining for the lead

3. Succeed *

Please detail the nominee�s success. How has she used leadership to successfully implement or promote a technology, management principle or process; or has led a company to remarkable financial performance. Please list any other industry awards/recognition that the nominee has received here. Maximum 1650 characters (200 words).

1650 characters remaining for the succeed

Additional Info: *

Please provide any additional background information to support this nomination. Maximum 1650 characters (200 words). �

1650 characters remaining for the addtional info