Please complete this form to nominate anyone who has made a direct impact in your community and a positive impact on young women's lives in your community.

Simply fill in your details and theirs below and hit submit to send us your nomination. On the following page there is the opportunity to send us an accompanying photograph or to upload a video.

Note: This is not a vote. Please do not nominate the same person more than once. You must know the person you are nominating personally. All fields are mandatory. Terms and Conditions.