Kimberly Jean-Pierre - Assembly District 11 |Assembly Member Directory | New York State Assembly

Thank you for taking the time to nominate an outstanding woman in your community. Nominations must be received by Monday, February 12^th. All nominees must reside in the 11th Assembly District.

Name of nominating individual

First Name

Last Name

Telephone of nominating individual

Email of nominating individual

Confirm Email

Address of nominating individual

Address Line 2

Apt Number

City

State

Zip

Name of nominee

Title

First Name

Middle Initial

Last Name

Suffix

Pronouns

Address of nominee

Apt Number

City

State

Zip

Telephone of nominee

Email of nominee

Confirm Email:

I wish to nominate the above-mentioned woman for a Women of Distinction Award in the following category

Education

Business

Health Care

Volunteerism

Community Services

Other

Please describe the nominee and her contribution

User Name