Nomination Form

100 ACCOMPLISHED BLACK CANADIAN WOMEN – ONLINE NOMINATION FORM

We are currently accepting nominations to be profiled in an educational document reflecting the accomplishments of 100 Accomplished Black Canadian Women. Our goal is to document and make visible, their accomplishments.

We invite you to submit nominations of women who are in (and not limited to) the following categories: government, not-for-profit, financial, legal, real estate, health, education/academic, entertainment, fine arts, unsung heroes, trailblazers, firsts, and posthumous heroes.

Nomination Criteria

  • Lives and works in Canada at the time of nomination submission
  • Demonstrated support for the advancement of Black women and girls
  • Actively engages in activities with organizations and groups that support Black women and girls
  • Demonstrates leadership through role modelling and/or volunteer activities.
  • Demonstrates 3 major accomplishments or achievements over the past 10 years.

Deadline for Nominations: October 31, 2017

Nominee Information
FULL NAME (plus any middle initial or nickname used) (required)

Title

Organization name

Organization's mailing address

Email address (required)

Phone number

Secondary contact's name/e-mail

Nominated by
Name (required)

Title

Organization name

Organization's mailing address

Email address (required)

Phone number

Mobile number

Secondary contact's name/e-mail

Reason for Nomination
Briefly describe why this individual should be considered)
(100 words or less, with a focus on accomplishments and contributions to the community.)