Girls Inc. Alumnae Impact Award Application
The Girls Inc. Alumnae Impact Award honors a former Girls Inc. participant whose life and work create meaningful and lasting impact in her community. The recipient exemplifies the Girls Inc. mission and serves as a role model who uplifts others and inspires girls to be strong, smart, and bold.
Nominee Information
Full Name
*
Prefix
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Occupation or Title
*
Employer or Organization
Girls Inc. Affiliation
Emergency Contact Phone Number
Please enter a valid phone number.
Location or program attended
*
Years attended
*
Years involved
Programs, clubs, or activities participated in
Share your Girls Inc memory or experience
Nominator Information
Leave blank if self-nomination
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship to Nominee
Nomination Questions
Please respond as clearly and fully as possible. Each question helps the committee evaluate alignment with the Girls Inc. mission and award criteria.
Leadership and Role Modeling
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Describe how the nominee demonstrates leadership and serves as a positive role model in her career, community, or personal life.
Community or Professional Impact
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Explain how the nominee’s work or service has created meaningful and lasting impact. Please include specific examples when possible.
Commitment to Uplifting Girls and Women
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Describe how the nominee contributes to the empowerment of girls or women through mentorship, advocacy, leadership, or community engagement.
Alignment with Girls Inc. Mission and Values
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Explain why the nominee represents the spirit and values of Girls Inc. and why she should be honored with this award.
Embodiment of Strong, Smart, and Bold Values
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Share how the nominee reflects the Girls Inc. mission through her actions, resilience, growth, and advocacy.
Supporting Materials
Please upload any of the following optional materials:• Letter of support or recommendation• Resume or brief bio• News articles, links, or examples of impact• Photos (headshot or action photos)
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Certification
By submitting this nomination, I certify that the information provided is accurate to the best of my knowledge.
Nominator Signature (typed):
Date
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Month
-
Day
Year
Date
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