The Burlington County Advisory Council on Women is pleased to announce it is seeking nominations for the Outstanding Women of Burlington County Award.

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1 Dianne Mills McKay, Council Chairperson Zahirah Sabir, Council Staff Phone: Fax: Mailing Address Department of Human Services 795 Woodlane Road Westampton, NJ October 2015 The Burlington County Advisory Council on Women is pleased to announce it is seeking nominations for the Outstanding Women of Burlington County Award. Each year, the Advisory Council and the Burlington County Board of Chosen Freeholders honor women who have made a difference within the Burlington County community. The council is looking for women who have made significant contributions as well as having demonstrated their support of women. They may have acted as mentors, role models, or advocates for other women. In short, the council is looking for those women of achievement who have helped other women achieve their goals. As a community leader, you may know of an individual who merits special recognition. To be eligible, a nominee must have lived or worked in Burlington County for at least one year. We invite you or your organization to submit a nomination for consideration. Only individual women, not groups, clubs, or organizations will be considered for this award. A nomination form is enclosed. In the past we have recognized people from the different categories such as Education, Government, Public Service, Volunteerism, Journalism, Arts, Entertainment, Law, Business, Entrepreneur, Medicine, Health Services or Social Services. All nominations must be received by 4:00 PM on December, 4, Award presentations will be made at the annual Outstanding Women of Burlington County Awards Dinner to be held Thursday, March 31, Nomination forms may be mailed, faxed or hand delivered to: Ms. Zahirah Sabir Burlington County Department of Human Services 795 Woodlane Road P.O. Box 6000 Westampton, New Jersey zsabir@co.burlington.nj.us Fax: (609) Forms are available on our website: Women For more information concerning award requirements, please contact Ms. Sabir at: (609)

2 OUTSTANDING WOMEN OF BURLINGTON COUNTY AWARD 2016 NOMINATION FORM Please cite ways in which the nominee has demonstrated outstanding performance or dedication to her job and/or community, as well as specific examples of her support of women. Please be as specific as possible regarding the nominee's qualifications. The detailed description which you craft for the nominee has a great influence on the selection process. Specific information/specific facts provide rich detail which helps to paint a complete portrait of the nominee. Responses should be typed, double spaced and attached with this application. This form is available in Word format on our website: Nomination Deadline: 4 PM, December 4, 2015 NOMINATION CATEGORY: CANDIDATE INFORMATION: NOMINEE: ADDRESS: PHONE: NOMINATOR S INFORMATION: NAME: RELATIONSHIP TO NOMINEE: ADDRESS: PHONE:

3 REFERENCE INFORMATION: PLEASE PROVIDE ONE REFERENCE WHO IS ALSO FAMILIAR WITH THE NOMINEE AND CAN VERIFY THE INFORMATION SET FORTH IN THIS NOMINATION FORM: NAME: RELATIONSHIP TO NOMINEE: TELEPHONE: Please provide information about the nominee in each of the areas provided below: 1. Education 2. Employment 3. Professional organizations and activities 4. Volunteerism and community activities 5. Activities demonstrating support of women 6. Other pertinent information you would like to include to support your nominee, you may wish to include their family life; (Members of the family with whom they reside, their culture, family traditions, personal obstacles overcome, etc.) Award presentations: Our ceremony date will be Thursday, March 31, 2016 in honor of Women s History Month. ** Thank you for your time. **

4 Applications must be received by December 4th! 2016 OUTSTANDING WOMEN OF BURLINGTON COUNTY AWARDS Celeste Arties Memorial Award Elizabeth Coleman White STEM Award Alice Paul Champion Award NOMINATION FORM Access this form online in Word format at: Responses should be attached on a separate sheet of paper, typed and double spaced and mailed to the address at the end of the next page. The detailed description which you craft for the nominee has a great influence on the selection process. Specific information/specific facts provide rich detail which helps to paint a complete portrait of the nominee. This year, the Council is pleased to be awarding three Scholarships, each in the amount of $ , to the award recipients. Please fill out a separate form for each nomination category. Nomination Deadline: 4 PM, December 4, 2015 CANDIDATE INFORMATION: NOMINEE: ADDRESS: PHONE: SCHOOL: CATEGORY: NOMINATOR S INFORMATION: NOMINATOR S - NAME: RELATIONSHIP TO NOMINEES: ADDRESS: PHONE:

5 *Please attach a copy of the students transcripts to this application, as well as any other supporting materials which might aid the council in making its determination as to the most worthy recipients. Answer the following questions in narrative form on a separate sheet of paper: What are your post secondary educational plans/career goals? Name the school organizations/activities in which you have participated. Name the volunteer/community activities in which you have participated. Please describe any activities demonstrating support of women. Please be specific. Other pertinent information you would like to include supporting your nomination. You may wish to include your family life. (Members of the family with whom you reside, culture, family traditions, personal obstacles overcome, etc.) Celeste Arties Memorial Award ESSAY: If you could have dinner with any woman in the past, present or future, who would she be and why? Elizabeth Coleman White STEM Award ESSAY: What field(s) of study in STEM are you hoping to pursue and why do you have an interest in this field of study? Alice Paul Champion Award ESSAY: Alice Paul was a fierce advocate of women s equality issues, particularly the right to vote and gender equality guaranteed by the Constitution. Today women have the right to vote, however equality has not been fully achieved. Which issue affecting women (examples below) is the most important to you and what would be your plan to address it? 1. Pay Equity 2. Family Medical Leave 3. Violence against women 4. The disproportionate representation of women in elected office The Alice Paul Champion Award is given in partnership with the Alice Paul Institute. For more information on the Institute and their programs please visit Award presentations: Our ceremony date will be Thursday, March 31, 2015 in honor of Women s History Month. Please note that the Celeste Arties Outstanding Student Scholarship is geared towards a student seeking an education outside of the STEM field. The Elizabeth White STEM Award is particularly geared towards a young lady pursuing an education and future career in Science Technology Engineering & Math. ** Thank you for your time and sharing this opportunity with students. **