Request edit access
Visionary Awards candidate application
Each honoree will need to make him or herself available for a couple hours on one day to shoot a short 3-minute film to be shown at the event. Also please note that this honor is for an individual person and their company, not for a partnership or a network of people.

Thank you for your interest in this award!

Email address *
Your name (if different from candidate)
Your first and last name & your relationship to candidate
Your answer
Your email (if different from candidate)
Your answer
Name of candidate *
First and last name
Your answer
Candidate's email *
Your answer
Candidate's phone number *
Your answer
Name of Company *
Your answer
Number of employees in Berkeley *
Your answer
What is the candidate's connection to Berkeley? *
Required
Describe the market sector of the company:
Your answer
What is the story of this company: Its goals? How long until it reaches those goals?
Your answer
What is this company's stage of maturity (e.g.): years since launch, revenue generated, number of customers?
Your answer
What other awards has the candidate of their company received?
Your answer
In what way is this person/company a Visionary?
Your answer
How does this person/company contribute to Berkeley's innovation ecosystem?
Your answer
What values does this person/company have that are consistent with the Visionary Awards and Berkeley? Does this person/company exemplify "innovation with a conscience?"
Your answer
Is this person a good speaker? Charismatic?
Shy, Quiet, Doesn't like public speaking
Gregarious, Charismatic, Great public speaker
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Berkeley Chamber of Commerce. Report Abuse - Terms of Service - Additional Terms