Phil Steck - Assembly District 110 |Assembly Member Directory

Thank you for choosing to nominate an exceptional woman who deserves recognition for dedicating her time, energy and passion to making our community a better place! Please fill out all of the information below to ensure that we can accurately and appropriately recognize your nominee.

A PDF Version of the nomination form is attached, To nominate an individual, please print it out and mail the form to our District office: 1609 Union Street Schenectady, NY 12309

1. Nominator Name

Title

First Name

Middle Initial

Last Name

Suffix

Pronouns

2. Nominator Address

Apt Number

City

State

Zip

3. Nominator Phone

4. Nominator Email

Confirm Email:

5. Name of nominee

Title

First Name

Middle Initial

Last Name

Suffix

Pronouns

6. Address of nominee

Apt Number

City

State

Zip

7. Telephone of nominee

8. Email of nominee

Confirm Email:

9. I wish to nominate the above-named woman for Assemblymember Phil Steck’s Women of Distinction Award in the following category

Education

Business

Health Care

Humanitarian Work

Military Service

Community / Civic Affairs

Volunteerism

Government

Other

10. Please describe the nominee and her contribution

User Name