Mabel Sine Wadsworth Women's Health Achievement Award

Nomination Form

Criteria for Award:

The Mabel Sine Wadsworth Women's Health Achievement Award is given annually to a Maine person who has demonstrated a remarkable contribution to feminist principles in women's health care.  Recipients have been actively involved as volunteers and/or paid workers in improving the health care of Maine women over a significant period of time.  Recipients demonstrate commitment to the following:

1. Grass roots health care education that promotes self-determination and reproductive freedom of choice for all women.
2. Access to quality health care for women with low incomes.
3. Full health care rights for lesbian women and gay men.
4. Fostering connections among diverse groups around women's health care issues.

Please provide the following information, along with a nomination statement that speaks to the above criteria (500 words or less).  Nominations are accepted throughtout the year.

(Please print or type)

Name of Nominee________________________________________________________________

Address_______________________________________________________________________

Telephone(day)____________________(evening)______________email_____________________

Your Name_____________________________________________________________________

Address________________________________________________________________________

Telephone(day)___________________(evening)_______________email______________________

    Nomination Statement

(Please use back of form, if more space needed)