Nomination Form

“ALL NOMINATIONS ARE CONFIDENTIAL—NO NOMINEE SHOULD KNOW OF HER NOMINATION”

NOMINATIONS ARE NOW CLOSED

Confirmation Email Address

E-mail address of person filling out the form *

Nominee

Nominee's Name *

Nominee's Home Address *

Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Nominee's Personal Phone *

Nominee's Personal Email *

Years of Residence in Pennsylvania

Business

Nominee's Business Address *

Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Nominee's Business Phone *

Nominee's Business E-mail *

Submitting Officer

Submitting Officer's Name *

Submitting Officer's Title *

Submitting Officer's Phone *

Describe your relationship with the Nominee *

Sponsoring Organization

Sponsoring Organization *

Sponsoring Organization's E-mail *

Sponsoring Organization's Phone *

Sponsoring Organization's Address *

Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

In filling out the form below, please stay within the listed parameters of the information you are providing. Any additional information submitted will be disregarded.

Summary of Qualifications

Nominating Letter *

Must be in PDF or Word format.

Attachments will ONLY be uploaded when the form is submitted, NOT saved

Summary
Please summarize below why the nominee should be named a Distinguished Daughter of Pennsylvania? (3 paragraphs maximum) *

character limit: 1500

Nominee's Education *

Nominee's 5 Major Accomplishments
(chronological beginning with the most recent) *

Professional Positions
(chronological beginning with the most recent - 8 maximum) *

Significant Volunteer Service
(chronological beginning with the most recent) *

Awards
(International, National, Regional, Local - 10 maximum) *

Optional Seconding Letters
(must be on organization letterhead)

Letter # 1

Letter # 2

Attachments will ONLY be uploaded when the form is submitted, NOT saved

Photo

File Upload *

Please include 1 head and shoulders jpg, jpeg, png or gif photo of the nominee.

Attachments will ONLY be uploaded when the form is submitted, NOT saved

Verification

Distinguished Daughters of Pennsylvania is a project of The Foundation for Enhancing Communities, fiscal sponsor.

The official registration and financial information of The Foundation for Enhancing Communities may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement. The Foundation for Enhancing Communities is registered in each state requiring such registration.

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