February 5, 2025 Javascript must be enabled to properly view this page. * Indicates Required Field Name of the Nominator * Address of Nominator * (Street Address, P.O. Box, Company Name, c/o) Street Address, P.O. Box, Company Name, c/o Suite, Unit, Building, Floor, etc. Apartment, Suite, Unit, Building, Floor, etc. Apt Number City * State * New York New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Email of Nominator * Confirm Email:* Must match the corresponding email fieldMust match the corresponding email field Phone Number of Nominator * Name of the Nominee * Nominee falls under the following category: * Education Military Service or Law Enforcement Community/Civic Affairs Health Care Volunteerism Businesswoman Other Address of Nominee * (Street Address, P.O. Box, Company Name, c/o) Street Address, P.O. Box, Company Name, c/o Suite, Unit, Building, Floor, etc. Apartment, Suite, Unit, Building, Floor, etc. Apt Number City * State * New York New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Phone Number of Nominee * Email of Nominee * Confirm Email:* Must match the corresponding email fieldMust match the corresponding email field Please give a short description of the nominee and her contribution to the community: * User Name
