Application

Up to three letters of recommendation are highly encouraged due to the quantity of applicants for this award. (More than three letters will not be accepted.) Please fill out this form to submit any supporting materials.

IMPORTANT ELIGIBILITY NOTE: To be eligible for this award, the nominee must live or work in the state of Maryland. If the nominee is not employed in Maryland, they must show a significant impact on Maryland through community work and mentoring. A winner is not eligible to win again the following year but can win a maximum of three times. Three-time winners are inducted into the Circle of Excellence. Honorees for this award are chosen by a panel of judges composed of past honorees.

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URL

This field is for validation purposes and should be left unchanged.

Are you nominating yourself for this award? (Note: This is for The Daily Record's recordkeeping only. It WILL NOT be considered by judging panel.)*

Yes

Honoree Name (as you would like it to appear in print and on an award)*

First Last

Please spell out the pronunciation of your whole name (for announcing on stage during awards ceremony)*

For example: "Jay-Cubs" for "Jacobs"

Position Title*

Company/Organization*

Please type the name of your company as how you would like to see it in print

Address*

Street Address Address Line 2 City State ZIP Code

County Employed In*

Phone number, including area code*

Preferred Email Address*

If there is another email address that should be included in communications about this event, include it here.

Facebook Profile URL

(e.g. http://www.facebook/johndoe)

LinkedIn Profile URL

(e.g. http://www.linkedin.com/profileview?id=1234567)

X (Twitter) Handle

(e.g. @johndoe)

Fax Number

Please upload a high-resolution headshot. (This may be used in the awards ceremony or publication.)

Please ensure that your photo(s) are no smaller than 1 MB in size. Email [email protected] with any issues.

Accepted file types: jpg, png, Max. file size: 8 MB.

Number of Employees You Supervise*

Company Product/Service Description*

Please provide a brief biography (300-400 words):*

Education: List most recent first and include degree, institution and year graduated*

Career History: List most recent and include start an end year, company and title*

Corporate Board Seats Held*

List most recent first and include Year and Corporation

Most Significant Accomplishment*

Professionally, what do you consider your most significant accomplishment to be?

Example of Mentoring*

Please give ONE example that demonstrates how you have mentored others outside of the guidance you provide to your direct reports.

Officer/board membership in professional organizations (Include volunteer and career-related organizations): Limit to past 10 years, list most recent first and include year, position held and organization*

Awards/Honors*

What awards have you been most proud to receive? List most recent first and include Year, Award/Honor Name and Awarding Institution

Most Significant Personal Accomplishment*

Excluding family, on a personal basis, what do you consider your most significant accomplishment to be?

Have you previously been named one of Maryland's Top 100 Women?*

If so, what year?

Birthplace & Date (mm/dd/yyyy)*