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Nomination Form


The national theme for the 2012 National Women's History Month is Women's Education – Women's Empowerment. We are looking to honor women who contribute to the support and advancement of women. Their contributions might include, but are not limited to, the following:

  • Volunteer/community work
  • Leadership positions
  • Support for the goals and interests of women in the community
  • Role model/mentor for others
  • Organizer of campus or community events
  • Voicing women's concerns on campus or in the community
  • Working to expand the vision of equality for women

Please supply the following information about your nominee, and submit this form with a letter of nomination. The letter should be no more than 2 pages; address the criteria listed above; and answer the following questions:

  1. Please tell us how you know the individual.
  2. Please describe why you feel this individual is deserving of this recognition.
  3. In what ways has this person contributed to the support and advancement of women.
  4. Contact information for both the nominator and the nominee.

Completed nominations may be sent by e-mail to or through US or Campus Mail to Meriem Pages,Mail Stop # 1402, Keene State College, 229 Main Street, Keene NH 03435-1402. All nominations must be received by Friday January 20, 2012.

Thank you in advance for your nomination.

Nomination Form

Nominee's Name:
Category (circle one): KSC Student   KSC Faculty/Staff   Monadnock Region   State of NH

Your name:
E-mail address:


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