TiECON Southeast 2012 Awards - Corporate Intrapreneur of the Year Survey

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Nominee Information

Nominee Information Name:
Company:
Title:
Email Address:
Phone Number:

Nominee's Assistant (If applicable)

Nominee's Assistant (If applicable) Name:
Email Address:
Phone Number:

Nominator (if different from the nominee)

Nominator (if different from the nominee) Name:
Company:
Title:
Phone Number:
Email Address:
Phone Number:

Your affiliation with the nominee

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Decribe your company in two sentences.

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Describe your innovative corporate product, service or solution in three sentences.

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What is your 3-5 year vision for this internal initiative?

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Describe the untapped or newly created market. (<200 words)

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Please list significant milestones regarding your internal initiative. (please use bullets)

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Describe your biggest obstacle. (less than 200 words)

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Which lines of business, executives and/or board members required buy-in, in order to implement your initiative? (Please use bullets)

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Describe the person being nominated, role and responsibilies. (<150 words)

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List any current or previous additional information about the nominee i.e. awards, community involvement, mentoring, for-profit and/or non-profit board positions, member of organizations, etc. (Please use bullets)

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Additional information regarding you or your company achievements, i.e. unique challenges, etc. (< 200 words)

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I CERTIFY THAT ALL INFORMATION IS CORRECT.

I CERTIFY THAT ALL INFORMATION IS CORRECT. Yes

TiECON Southeast 2012 Awards - Corporate Intrapreneur of the Year

"Corporate Intrapreneur" - Nomination Form