2017 Nomination Form “Champions of Diversity Award” Name of the Person being Nominated Title * Organization/Affiliation * Street Address * City * State * ZIP * Phone * Mobile * Email Address * Date_Nominated * Field name is required I.Enhancement: * II. Effectiveness: * III.Impact: * IV. Uniqueness: V. Longevity: * VI. Service: * VII. Commitment: * Submit Please attach supportive information with nomination, if more space is needed. Also please attach any hi-res pictures of the nominee if you have one. Thank you for your nomination! Entrepreneurs Hall of Fame 2017 Nomination Form Nominees Name * Title * Organization/Affiliation * Street Address * City * State * ZIP * Phone * Mobile * Email Address * Executive Assistant’s Name Phone * Email Address * Year established * Number of employees * Business Description * Field name is required 1. How long have you known candidate? * 2. In what capacity do you know the candidate? * 3. What leadership qualities does the candidate possess and in what ways has she/he been effective in building and fostering cohesive relationships among all key stakeholders (peers, staff and customers and may also include upper management)? * 4. What are the nominees defining core competencies and how have they leverage these advantages to separate themselves from other successful entrepreneurs. (Please list specific examples) 5. What are some of the strategic innovative strategies and solutions the candidate incorporated that led to significantly growing their business while also, enhancing the profitability and value of their organization? * 6. What contributions has the candidate made to further impact the community, educational and professional organizations they serve? * 7. Please provide other awards and accolades the candidate has won. * 8. What other additional and/or worthwhile information would you like the committee to have as they make their decision regarding the candidate? Submit Please attach supportive information with nomination, if more space is needed. ***Also please attach any hi-res pictures of the nominee if you have one.*** Thank you for your nomination!