2010 FIRST LADY NOMINATION FORM
Due April 5, 2010 at 5:00 pm
Nominator Information
Name (First & Last) Nominee Association (e.g., Aunt, Uncle, Employer, Child) DOB
Address City, State, Zip Code
Daytime or Cell Phone E-Mail
Nominee Information:
Please select nominee type (One response only): High School Diploma College Degree Business Owner
Nominee’s Name Nominee’s DOB
Nominee’s Address City, State, Zip Code
Employer Title
Daytime Phone Cell Phone
E-mail Web site (for Business Owner)
I attest the information included for this nomination is true to the best of my knowledge.
Printed Name or Typed Name Signature Today’s Date
Nomination Check List
Please include the following with this nomination form:
A 500 word or fewer essay responding to the following:
1. Why should the nominee be considered for The First Lady Award?
2. What tangible and intangible impact did the nominee make in her life, her family, or
community when she received her high school diploma, college degree, or launched her
business?
3. How many children does the nominee have and what are their ages?
4. Do the nominee’s children live with her?
5. What additional impact(s) do you believe The First Lady Award will make in the live of the
nominee and her family?
Proof of Prince George’s County Residency
Proof of Employment Status (e.g., acceptance letter, check stub)
Copy of High School Diploma with a Seal
Copy of College Degree with a Seal
Business Certificate of Good Standing and a client letter of recommendation for nomination
Please complete and email, mail, or fax form accompanied with requested attachments:
Via Mail:
Ms. Sherra M. Jackson
Community Relations Associate
Virtuous Enterprises, Inc.
4305 St. Barnabas Road,
Temple Hills, MD 20748
Via Email: sjackson@veinc.org
Via Fax: 301.316.1956
Nominations without requested documentation will not be considered.
A 500 word or fewer essay responding to the following:
1. Why should the nominee be considered for The First Lady Award?
2. What tangible and intangible impact did the nominee make in her life, her family, or
community when she received her high school diploma, college degree, or launched her
business?
3. How many children does the nominee have and what are their ages?
4. Do the nominee’s children live with her? Yes No
5. What additional impact(s) do you believe The First Lady Award will make in the live of the
nominee and her family?