Small Business Recognition Awards
2006 Online Nomination Form
Please note that you cannot save this form to complete later.  It is recommended that you print this out, ensure that you have all the required information including the 750 word (maximum) activity summary, and then come back later to complete on line.
Instructions and Submittal Deadline
This online nomination form and activity summary (below) should be submitted electronically. No more than five pages of supporting materials may be emailed. If you cannot submit electronically or prefer to mail or fax hard copy materials, you may download the application to print out HERE. Please mail or fax to Linda Hayes-Gorman at the address/fax below.

This online form and all accompanying materials must be submitted by 4:00 pm EST, January 17, 2006. If you are submitting materials by mail or fax, the hard copy application, activity summary (up to 750 words), and any supplemental information (up to 5 pages total) must be RECEIVED by Linda Hayes-Gorman by the same date, January 17, 2006.  Please contact Linda Hayes-Gorman or Amelia Gooding (below) with any questions.

Linda Hayes-Gorman
Awards Subcommittee Chair
Air Quality Business Assistance Program
OR Department of Environmental Quality
2146 NE 4th Street
Bend, OR 97701
Email: hayes-gorman.linda@deq.state.or.us
Phone: (541) 388-6146, x274
Fax: (541) 388-8283
 Amelia Gooding
Awards Subcommittee Vice-Chair
Small Business Environmental Assistance Program
IL Department of Commerce and Economic Opportunity
620 E. Adams, 4th Floor
Springfield, IL 62701
Email: agooding@ildceo.net
Phone: (217) 785-4557
Fax: (217) 557-2853

Nominee
Email
Phone
Address
County
Contact Person  
Email
Phone
Address
Your Name (nominator)  
Email
Phone
Address
Category of Nomination
  Small Business Assistance Program
  Small Business Environmental Stewardship
  Trade Association Environmental Leadership

 
ACTIVITY SUMMARY

Please provide an activity summary of up to 750 words addressing the nomination questions outlined for each Small Business Award.  PLEASE NOTE THAT YOU CANNOT SAVE AND COME BACK LATER; it is recommended that you develop the activity summary off line in WORD or another program with word counting capabilities and then cut and paste into this block when you are ready to complete the online submittal in entirety.
Word Count:


CLICK HERE:  hayes-gorman.linda@deq.state.or.us to email optional supplemental attachments to support the above activity summary -- NOT TO EXCEED 5 PAGES TOTAL. If your web browser does not support an email default function, please cut and paste the email address into your own email program.