International Women's Day - Rotarian Award Nomination Form
YES! I want to honor a fellow Rotarian who is leading the way in outstanding local and international humanitarian service.
Email address *
** IMPORTANT - To save your progress, click on the "SUBMIT" button at the bottom of this form. You can return to this form to add/edit. **
Club President who is submitting this nomination:
What is your first name?
What is your last name?
What is your club's name?
Phone number where you can be reached?
Please enter your mailing address:
Nominee's Contact Information
What is the nominee's first name?
What is the nominee's last name?
What is the nominee's email address?
Please confirm that the nominee is not currently a District 7430 Officer, or a member in the District Leadership Team (DLT), or an incoming DLT Elect or Nominee.
Clear selection
If the nominee were to be selected to receive the Community Award, is she available on March 11, 2021? Please confirm.
Clear selection
Has the nominee been an active Rotarian for more than a year and is she a Rotarian in good standing? Please verify and provide the name of the first Rotary club and the date she joined. If she has been a Rotarian with more than one Club, please provide the names of the clubs, the dates she joined each club and the dates she transferred to another club. To include the reason for the transfers is optional.
What are the significant local projects in which has been actively involved, since when, in what capacity and which of Rotary’s Six Areas of Focus addressed?
What are the measurable results and the positive impact of these local projects on the community? How has the community benefitted from these projects?
Whose involvement and support have such local projects included? The nominee's Rotary club alone or in partnership with other local clubs, District 7430, or The Rotary Foundation? Did it receive Club or TRF grants? If so, what type of grant and in what amounts? If not, how were the funds raised?
What are the International projects, beyond fundraising, in which this nominee has been actively involved, since when, in what capacity, with what results and which of Rotary’s Six Areas of Focus addressed? Examples of international projects beyond fundraising are shown on the Extended Rotary Award Eligibility Criteria you should have already received.
Is the nominee a Rotary Foundation donor? What recognitions has she been awarded, i.e., EREY, Paul Harris Fellow, Multiple Paul Harris, Paul Harris Foundation, Major Donor, etc.? Please confirm and list.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy