2014 Official Nomination Form

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1 2014 Official Nomination Form Prior to completing the nomination form, please see the Women of Worth Overview on page 4. Section I Nominator A. Are you nominating yourself for this award Yes (proceed to Section II) B. Nominator Contact Information No (please complete the nominator contact information section below) Name (indicate Miss, Ms, Mrs, Mr) Title Organization Name (if Any) (Area Code) HOME Number (Area Code) WORK Number (Area Code) FAX Number Address City State Zip Code Job Title Address Section II Nominee A. Nominee Contact Information Name (indicate Miss, Ms, Mrs) Title Age Range* (Area Code) HOME Number (Area Code) WORK Number (Area Code) FAX Number Address City State Zip Code Job Title Address Website *Nominations will be organized into five groups by decades: year olds, year olds, year olds, year olds, 60+ year olds.

2 B. Nominee s Volunteer Service Does the nominee receive compensation for any portion of their volunteer service? Must be a legal resident of the 50 United States of America and the District of Columbia. Void in other US territories and where prohibited by law. Note: Nominees that receive a salary are not eligible. Salary Stipend No Compensation Nominee cannot be paid for their nominated volunteer service and their nominated service cannot include court-ordered community service. However, nominees who receive a nominal stipend for their service (e.g. those volunteering through a national service program such as AmeriCorps) should contact Points of Light (WomenofWorth@PointsofLight.org) regarding eligibility. Is the nominee s volunteer service performed with any organization? Yes No When did the nominee s volunteer service begin? (Month and Year e.g. June 2004)* Is the nominee currently participating in the service activity for which they are nominated?* Yes No *To be eligible, the volunteer activity should be of at least six months duration and should be ongoing. Approximately how many hours has the nominee devoted to volunteering for this cause?

3 Section III Organization Served By Nominee Please complete this section, if the nominee s volunteer service is performed with an organization. Please note that organization affiliation is not a requirement for this program. Name of organization served by nominee Contact person at organization (Area Code) HOME Number (Area Code) WORK Number (Area Code) FAX Number Address City State Zip Code Address Organization Website Facebook link Twitter link Organization s mission statement or purpose (500 character count limit)

4 Section IV. Description of Nominee s Volunteer Work Please answer the following questions with as much relevant, factual information as possible. Max 500 characters per question. 1. Describe the who, what, where, why, and how of the nominee s volunteer service. 2. Describe the impact of the nominee s volunteer service in their community (E.g., What services were improved or provided? How many people were helped? How much money was raised?) 3. How is the nominee s work innovative or unique in meeting community needs? 4. What makes this nominee a Woman of Worth? Why is her volunteer work extraordinary? Please choose one word to describe her. Note Nominators may submit 3 additional materials, such as press clippings, video or other materials in support of the nomination. Section V. Other A. Would you like to be ed regarding Women of Worth updates on your nomination status, judging results and winner information? Yes No B. How did you hear about the Women of Worth program? Women of Worth Website Women of Worth Advertising Points of Light/HandsOn Network or affiliates Social Media Women of Worth Honoree Other C. Would you like to join L Oréal Paris society, our online beauty club and receive L Oréal Paris product news, beauty advice and special offers? Yes No

5 2014 Women of Worth Official Nomination Form Overview No purchase is necessary to nominate for the Women of Worth Award. Award nominees must be legal residents of the 50 United States or the District of Columbia. Must consent to the nomination and be 18 years or older at the time of nomination. All nominations must be received online by 11:59pm Eastern Time (ET) 6/25/2014or postmarked by 6/20/2014. Void where prohibited. See official rules for details at Nominators can submit 3 additional materials such as: press clippings, video and pictures in support of the nomination. Women selected as Honorees will be notified by telephone and /or mail by September 30, Award Each Honoree will receive a $10,000 donation in the Honoree s name to her most cherished cause (an accredited 501(c) 3 non-profit organization), a trip for her and one guest to New York City ($1,400 maximum of travel and hotel accommodation) and recognition for both her cause and her efforts. Nomination Judging Nominations will be organized into five groups by decades: year olds, year olds, year olds, year olds, 60+ year olds. A representative from each age group will be chosen based on the following criteria: Impact (40%) - Is there demonstrated impact (new program or activity begun, number of people served, etc.) resulting from the nominee's activities? Community Needs and Solutions (25%) - Do the nominee's activities meet a real community need or concern? Community needs are broadly defined as providing food, shelter, and access to healthcare, providing arts programming or activities, strengthening educational programs, or providing enrichment activities that benefit children. Passion (20%) - Is the nominee's activity exemplary of their true inner passions? How is the nominee being true to herself through volunteer work? Innovation (15%) - Do the nominee's activities reflect an innovative or unique approach to meeting community needs?

6 Submission The L Oréal Paris Women of Worth Award Program is administered by Points of Light Institute. Please completed nomination forms to: WomenofWorth@Pointsoflight.org Or mail completed nomination forms to: Women of Worth Award c/o Points of Light 600 Means Street Suite 210 Atlanta, GA 30318

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