UMEA's Award Nomination Form
Thank you for taking time to fill-out this award nomination form. Self-Nominations are also welcome due to the fact that UMEA may not always be aware of your accomplishments.
* Required
Email address
*
Your email
Name of Award
*
Your answer
Your Name:
*
Your answer
Email address and Cell phone # of the individual who is nominating:
*
Your answer
Nominee's Name (please provide correct spelling)
*
Your answer
Nominee's Company/Organization (please provide correct spelling)
*
Your answer
Business Mailing Address City, State, Zip Code
*
Your answer
Physical location if different from Business Mailing Address
Your answer
Phone # 1 (Cell # preferred)
*
Your answer
Phone 2 (Work #)
Your answer
Nominee's business is owned and operated by
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Asian
Black or African-American
Hispanic, Latino, or LatinX
Native Hawaiian or other Pacific Islander
Not Hispanic, Latino or LatinX
Other
Required
Is the Nominee a current member of UMEA?
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Yes
No
Not Sure of membership status
Nominee's entity is a. . .
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Business (DBA, LLC, LLP, S or C Corporation, Franchise)
Non-Profit: 501(c)3 organization
Other:
How many years has the Nominee been in business?
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1-7 years (Startup and Emerging)
8-10 years (Growth and Expanding)
Over 10 years (Mature)
Number of Employees, including the Nominee
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1-10
11-49
50-99
100 or more
Nominee's business engages Independent Contractors instead of Employees
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Yes
No
Both
Not sure
Does the Nominee hire other African-American, LatinX and minority workforce (employees and/or Independent Contractors)?
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Yes
No
If so, how many?
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1-10
11-49
50-99
100 or more
N/A
Does Nominee sell. . .
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Product
Service
Both Product and Service
Required
Nominee sells products and services. . .
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Online
Brick and Mortar
Home-based
Combination of the above
Required
What type of Products and Services does the Nominee sell, and what their industry?
*
Your answer
Is the Nominee MWBE-Certified by any entity?
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Yes
No
Perhaps
Please describe Nominee's company growth and achievements (check all the apply):
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Increased revenues
Added Employees
Expanded or relocated due to growth
Made capital expenditures due to growth
Received state or national recognition
Opened a business within the past year
Celebrated a significant milestone
Other
Required
Please describe the extent of Nominee's community involvement
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Your answer
Is there anything else you want us to know about the Nominee's business--why you (if you are nominating yourself) or s/he should be considered for this award?
*
Your answer
I understand that filling out this form in no way, shape or form means that I or my nominee will win an award.
*
Yes
No
Send me a copy of my responses.
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