Small Business Recognition Awards

2006 Print/Fax Nomination Form

You may fill in this form on the computer or by hand.  Print a hard copy, and mail or fax with the 750 word activity summary and optional supplementary attachments (up to 5 pages total) to Linda Hayes-Gorman (see contact information below).  If you prefer to complete on line, please go back to the information page and click on the bar "Go to Online Nomination Form."

All materials must be RECEIVED by Linda Hayes-Gorman by 4:00 pm EST on January 17, 2006.  Any nomination packages that do not meet guidelines (e.g., incomplete forms, activity summary over 750 words, supplemental information over 5 pages total) will be disqualified.  Please contact Linda Hayes-Gorman or Amelia Gooding (below) with any questions.

Nominee - 

Email - 

Phone - 

Address - 

County - 

Contact Person - 

Email - 

Phone - 

Address - 

Your Name (nominator) - 

Email - 

Phone - 

Address - 

Program Name  

Program Type (SBO/SBAP/CAP)

Approx. No. of Employees  

Industry Type  

Approx. No. of Members   

Industry Type  

ACTIVITY SUMMARY

Please provide an activity summary of up to 750 words addressing the nomination questions outlined for each Small Business Award.  It is recommended that you develop the activity summary in Word or another program with word counting capabilities.  Mail or fax this hard copy form, activity summary, and any supplemental information (up to 5 pages total) together to Linda Hayes-Gorman (above).