Nomination Form:

12th Annual Bethune Leadership Recognition Banquet

The Valdosta-Lowndes Metropolitan Section of the National Council of Negro Women, Inc. proudly invites nominations for the 12th Annual Bethune Leadership Recognition Banquet honoring outstanding women and girls whose leadership, service, advocacy, excellence, and community impact reflect the enduring legacy of Dr. Mary McLeod Bethune.

This prestigious recognition celebrates individuals who are making meaningful contributions throughout South Georgia through leadership, volunteerism, mentorship, education, civic engagement, entrepreneurship, public service, and community empowerment.

ELIGIBILITY REQUIREMENTS

Nominees must:

Nominees must be women or girls
Demonstrate leadership, service, advocacy, academic achievement, or community impact
Nominees must reside in or actively serve one of the following South Georgia counties: Lowndes, Brooks, Berrien, Clinch, Colquitt, Lanier, Tift, Echols, Cook, or Atkinson County

Instructions for Submitting a Nomination

Please complete all required sections thoroughly and accurately.

Select the appropriate recognition category for the nominee.
Provide detailed responses highlighting the nominee’s leadership, accomplishments, and community impact.
Upload all required supporting materials and documentation.
Submit the nomination fee associated with the selected recognition category.
Ensure all materials and payments are submitted before the deadline.

After submission and payment are received, the nominee will receive additional banquet and event information via email.

Nominator Information

Nominator or Organization's name

Please provide the full name of the individual or organization submitting this nomination.

Provide a valid email address for nomination updates, confirmations, and event communication.

Phone Number

Please provide a direct contact number for questions regarding the nomination.

Nominee Information

First name

Enter the nominee’s legal first name as it should appear in recognition materials and banquet programming.

Last name

Enter the nominee’s legal last name as it should appear in recognition materials and banquet programming.

Provide the nominee’s preferred email address for banquet and event communication.

Phone Number

Provide the nominee’s direct contact number.

Nominee's Address

Country/Region

Address

City

Zip / Postal code

County of Residence or Service Area

Select the county where the nominee resides or primarily serves.

Recognition Category

Nominee's Community level

Select the category that best represents the nominee.

LEADERSHIP & COMMUNITY IMPACT

How has the nominee demonstrated leadership and created a positive impact within her school, organization, profession, or community? *

Provide specific examples of leadership, service initiatives, mentorship, advocacy, volunteerism, program development, organizational involvement, or community impact. Include measurable outcomes, accomplishments, or ways the nominee has positively influenced others.

Why should this nominee receive the Bethune Leadership Recognition Award? *

Explain what makes this nominee exceptional and deserving of recognition. Highlight her character, dedication, influence, leadership qualities, integrity, commitment to service, and overall contributions to her community or field.

ACHIEVEMENTS & EXCELLENCE

Describe the nominee’s most significant accomplishments, achievements, recognitions, or contributions. *

Include academic, professional, civic, entrepreneurial, organizational, leadership, or community accomplishments. You may also include awards, certifications, honors, milestones, or major initiatives led by the nominee.

How has the nominee demonstrated a commitment to service, advocacy, mentorship, or empowerment? *

Describe how the nominee uplifts others through volunteerism, mentorship, advocacy, leadership development, education, outreach initiatives, or community engagement efforts. Include examples of long-term involvement and meaningful impact.

CHARACTER & LEGACY

How does the nominee embody the legacy and values of Dr. Mary McLeod Bethune? *

Describe how the nominee reflects the principles of leadership, education, empowerment, resilience, service, civic engagement, advocacy, and community advancement that align with Dr. Bethune’s enduring legacy.

Describe the nominee’s personal character, leadership qualities, and influence on others. *

Share examples of the nominee’s integrity, professionalism, compassion, resilience, collaboration, initiative, mentorship, or ability to inspire and motivate others within her community, organization, school, or profession.

OPTIONAL ADDITIONAL INFORMATION

Is there any additional information you would like the selection committee to consider?

Share any additional details, experiences, accomplishments, leadership initiatives, or personal qualities not addressed elsewhere in the nomination form.

Application Fee & Payment Information

Thank you for your nomination!

Please select the appropriate nomination level below and submit the corresponding application fee. The application fee covers the nominee's banquet ticket. After payment is received, the nominee will receive an information packet with event details.

Nomination Levels

Community Nomination$50

Collegiate Nomination$40

High School Nomination$40

Covers the nominee's banquet ticket.

Escort Fee:

If your nominee requires an escort, an additional $50 fee is required to cover escort accommodations.

Please note: The nominator is not responsible for this fee. It will be the responsibility of the nominee and/or the escort to submit this payment separately.

All nomination materials and payments are due by:

September 30, 2026, at 11:59 PM EST.

ACKNOWLEDGEMENT

Certification & Authorization *

By signing below, you certify that all information submitted is accurate and truthful to the best of your knowledge.