BPW WOMAN OF THE YEAR

Biographical Information Sheet

Name:             _______________________________________________________

Address:             _______________________________________________________

City:            ___________                       State:            _____________                  Zip:            ___________

Home Phone:             _____________                  Work Phone:            ________________

EDUCATION

High School:            ____________________________________________________________

City:            _________________________                      State:   _______________________

College/Technical:            ______________________________________________________

City:            __________________            State:   ___________________

EMPLOYMENT:

Present Employer:            ______________________________________________________

City:            ________________________                                    State:            __________________

Title:            __________________________________________________________________

Responsibilities: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Previous Employer:         _____________________________________________________

City:            _______________________                                      State:            __________________

Title:            __________________________________________________________________

Responsibilities: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ORGANIZATIONS

List organizations in which the nominee is involved and any offices she has held:

Ø                  __________________                        ________________________

Ø                  __________________                        ________________________

Ø                  __________________                        ________________________

Ø                  __________________                        ________________________

CONTRIBUTIONS TO THE COMMUNITY:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

POLITICAL ACTIVITIES:

____________________________________________________________________________________________________________________________________________________________

CONTRIBUTIONS TOWARD WOMEN HELPING WOMEN:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

WHAT PLACE DO YOU FEEL THE NOMINEE HOLDS AS A WOMAN IN THE BUSINESS WORLD?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

REFERENCES

1.         Name:            ___________________________________________________________

Relation to Nominee:            ______________________________________________________

Home Phone:            ___________________________      Work Phone:            __________________

[COMMENTS BY INTERVIEWER]

Attached to application

2.         Name:  ___________________________________________________________

Relation to Nominee:            ______________________________________________________

Home Phone:            ___________________________      Work Phone:            __________________

[COMMENTS BY INTERVIEWER]

Attached to application

3.         Name:  ___________________________________________________________

Relation to Nominee:            ______________________________________________________

Home Phone:            ___________________________      Work Phone:            __________________

[COMMENTS BY INTERVIEWER]

Attached to application

[QUESTION BY INTERVIEWER TO REFERENCES:]

WHAT HAS THIS NOMINEE DONE AS A CONTRIBUTION TOWARDS WORKING WOMEN IN THE COMMUNITY THAT WOULD MAKE HER WORTHY OF THIS AWARD?

Application Due back by September 19^th

Mail to:            Michele Wright            279-4812

                        157 Sunset Ave. – Camden, TN  38320

Nominated by: _________________________________            Date: ___________________