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2. 
   Women's Recognition Awards Form
   
4. Category
   1. Arts - Singer, Dancer, Actor, Performer, Artist, Composer, Musician, Author/Writer
   2. Business - Business Owner, Manager or Employee 
   3. Communications/Media - Radio, Television, Media, Newspaper/Publications, Editor, Writer/Reporter, Graphic Design, Technology 
   4. Community Service Professional - Professional or Paraprofessional (Paid Position) (i.e. Social Worker)
   5. Community Service Volunteer - A Volunteer in any Community Organization (Unpaid Position)
   6. Education - Primary, Secondary, and Post Graduate Levels- Teacher, Professor, Librarian or Administrator 
   7. Government - All Levels, Elected & Non-Elected 
   8. Health Care Providers - Nurse, Therapist, Social Worker 
   9. Law Enforcement/ First Responders - Police Officer, Law Enforcement Officer, Firefighter, EMS/EMT Provider
   10. Legal Profession - Judiciary, Attorney or Paralegal
   11. Medicine - Physician, Dentist or Veterinarian 
   12. Military - Active/Retired Members of the U.S. Armed Forces
   13. Religion - Religious Professional and/or involvement in religious activity 
   14. Science - Scientist or any professional involved in scientific research
   15. Sports - Athlete, Athletic Director, Coach or Sports Trainer
6. Award Category*

   (Choose from categories above)

8. Nominee*
10. Title/Position *
11. Organization*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Telephone Number*
20. Email*
22. Nominated by*
24. Phone Number
25. Email*
27. Address*
29. City*
30. State*
31. Zip Code*
35. Detailed evidence supporting this nomination must be enclosed, including:
    1. Resume or equivalent.
    2. Two letters of recommendation to be submitted by nominee's supervisors, colleagues or by those they serve (non-family members).
    3.  Demonstration of a positive impact in their community and going above and beyond in their role.

    A complete copy of this form must be submitted by Friday, January 27, 2023.

    For Further information, call Sharon Boyd at 631-451-6146 or email SBoyd@BrookhavenNY.gov

37. Upload Resume*
38. Upload First Letter of Recommendation*
40. Upload Second Letter of Recommendation*
41. Upload Even More Documents
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

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