*Employer or occupation:
*If a student, name of college/university:
*Check the eligibility requirement(s) met by your nominee:
Confirm current or past affiliation with Girl Scouts (ie. Girl member, parent, volunteer, mentor etc.)Nominee has strengthened Girl Scouting with her vision, initiative and leadership.Nominee has made significant contributions as a volunteer within her community, region, or nationally.Nominee has distinguished herself as a role model for girls or mentor for women.Nominee has challenged herself in a way that has created new opportunities for girls and/or women.Nominee has distinguished herself professionally
*Why is this woman a positive role model for girls and/or women?
*How has this individual made a positive impact on her community?
*Current or past affiliations with Girl Scouts (please note if applicable, participation level, special awards or recognitions, specific way Girl Scouting has shaped the woman she is today):
*Summarize significant and noteworthy career achievements:
*Additional thoughts or comments:
Upload a photo of the nominee or additional documentation.