2017 Racial Justice Award Nomination Form

2017 RACIAL JUSTICE AWARD NOMINATION FORM Why Nominate? This is your opportunity to nominate for recognition a woman, corporation, or organization having demonstrated a commitment to eliminating racism and promoting racial equality. The award will be presented at the 2017 Women for Racial Justice Breakfast on Monday, October 16th, 2017. Nomination Requirements:  A woman residing in the Pasadena-Foothill Valley region who is speaking out against racism and encouraging racial justice and interracial understanding.  A woman demonstrating a commitment to inclusiveness and racial harmony.  A business or corporation based in the Pasadena–Foothill Valley area that is implementing policies resulting in employment equity and supports their immediate community.  A community organization based in the Pasadena-Foothill Valley area that is addressing racial disparities.  Your nomination must demonstrate accomplishment and significant involvement in the struggle to eradicate racism. If your nominee is employed in the field of racial/social justice, their commitment must reflect efforts above and beyond the requirements of the job. Nomination Process : 1. Please complete the nomination form below. 2. Provide a statement of up to 500 words describing: "What inspired you to nominate this individual, corporation, or organization for the YWCA Racial Justice Award?” Please address: a) What specific steps has the nominee taken to further racial justice? b) How have their efforts created lasting change or made a significant difference in the struggle to eliminate racism? Previous Awardees: 2006 Constance Rice; 2008 Renatta Cooper; 2009 Marge Wyatt; 2010 Anthony Stewart; 2011 Toby Osos; 2012 National Hispanic Media Coalition; 2013 Dr. Jacquelyn Jacobs; 2014 Lorna Touryan Miller; 2015 Stella Murga; 2016 Dr. Melina Abdullah ************************************************************************************************************************ *********************************** NOMINATION FORM *YWCA Foothill Valley staff and volunteers are NOT eligible for nomination* Nominee: ______Business/Organization: ______

Contact Name & Title (if nominating a business or organization): ______Address: City: _____ Zip: ____ Daytime Phone: Evening Phone: ______Email: YOUR INFORMATION Your Name: Email: ______Address: _____City: ______Zip: Daytime Phone: ______Evening Phone:

Return Forms To: Jessica Kubel, Executive Director, RE: 2017 Racial Justice Award, YWCA Pasadena, 50 N. Hill Ave #301 Pasadena, CA 91106 | Ph: 626.296.8433 | Fax: 626.296.8433| Email: jkubel@ywca- pasadena.org DEADLINE: Nominations must be received no later than May 31, 2017, by 5:00 pm