WOY app

1. Central Connecticut Community Women’s Club P.O. Box 50, Cromwell, CT 06416
Cromwell’s Woman of the Year Award
The Woman of the Year Award is presented to a woman who has distinguished herself
through contributions to the community. Nominees should be Cromwell citizens not
currently serving as an elected official. Citizens or organizations may nominate a
candidate by completing this nomination form and returning it to the address listed on the
back.
Nominee’s name address, phone number(s):
Nominee’s occupation:
Why do you believe that the nominee is entitled to the award (in three sentences or less)?
List nominee’s activities, projects, or services, including community service, leadership,
education, challenges overcome and impact on community (use additional page if
necessary):

2. List organizations to which the nominee is currently or was previously involved in
(indicate offices held and approximate dates when possible):
List up to two references, including address and telephone number (you may attach
reference letters if available):
This nomination has been submitted by:
(name, address, phone number, e-mail address, relationship to nominee)
Mail to:
Central CT Community Women’s Club
P.O. Box 50
Cromwell, CT 06416
Questions? Contact Agnie Mena at (860) 508-0735
or e-mail agniemena@gmail.com.