2017 NOMINATION FORM

1

WHO ARE YOU NOMINATING (PERSON OR ENTITY) AND WHAT MAKES THEM WORTHY?

2

WHAT IS YOUR NOMINEE TRYING TO CHANGE, MAKE BETTER OR REVOLUTIONIZE?

Please limit details to 250 words or less for each of the questions.

NOMINEE CONTACT INFORMATION Provide the following contact information for the person, group, organization or company you are nominating.

NOMINEE NAME

NOMINEE EMAIL ADDRESS

NOMINEE PHONE NUMBER

NOMINATOR CONTACT INFORMATION

Provide the following contact information for yourself.

NOMINATOR NAME

NOMINATOR EMAIL ADDRESS

NOMINATOR PHONE NUMBER



ARE YOU AN EMPLOYEE OR FRIEND OF AN EMPLOYEE OF THE CHRONICLE HERALD? YES NO

EMPLOYEE NAME (IF YES WAS SELECTED ABOVE)

2017 NOMINATION FORM

3

WHAT MEASURABLE OR TANGIBLE IMPACT HAVE THEY ALREADY HAD?

4

EXPLAIN HOW YOUR NOMINEE HAS ACTIONED OR SHOWN A COMMITMENT TO THE ATTRIBUTES OF AN ENTREPRENEURIAL MINDSET OR ONE OF THE KEY DRIVERS OF CHANGE, OUTLINED ABOVE.

Please limit details to 250 words or less for each of the questions.

THANK YOU FOR YOUR NOMINATION! NOMINATIONS MUST BE SUBMITTED BEFORE SEPTEMBER 30, 2017 SEND YOUR COMPLETED NOMINATION FORM BY EMAIL TO [email protected]