EmpowerHer Impact Award Nomination Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

EmpowerHer Impact Award Nomination Form

Thank you for taking the time to nominate a woman who inspires you.

The EmpowerHer Impact Award honours a woman who leads with courage, compassion, and self-leadership, creating meaningful impact in her life and the lives of others.

If selected, the recipient will be invited to share her story as a guest speaker at the EmpowerHer Summit. Guidance and support will be provided to ensure a confident and meaningful experience.

Tell us who you are nominating and your connection to her.

Nominee Name *

Nominee Email (if available)

Nominator Name *

Nominator Email *

What is your relationship to the nominee? (e.g., friend, colleague, family) *

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms