TiECON Southeast 2012 Awards - College Student Entrepreneur of the Year Survey

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Nominee information:

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

Nominator information (if different than nominee)

Nominator information (if different than nominee) Name:
Phone Number:
E-mail Address:

Your affiliation with the nominee:

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During the timeframe listed above were you a full-time or part-time student and what is the name of your school?

Are you employed full-time or part-time by an outside company? (list company and number of hours per/week)

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What is your innovative idea? (<less than 150 words)

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What is your 3-5 year vision?

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What are your top three achievements to date? (<less than 200 words)

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What has been your top two obstacles? (<less than 200 words)

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Are you the recipient of any special grants any type of external funding. Are you participating in any special programs to assist you? (Please state "yes" or "no" if "yes" please give details)

If yes, to the question above, who assisted you with the process? (i.e. community leader, family member(s), friends, mentor, teacher, other - list all that apply and how they were influencial.

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Please share additional information you believe it would be beneficial for the judges to know. (<less than 200 words)

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I AGREE TO BE PRESENT FOR THE AWARDS ON SATURDAY, APRIL 28, 2012

I AGREE TO BE PRESENT FOR THE AWARDS ON SATURDAY, APRIL 28, 2012 Yes

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I CERTIFY THAT ALL INFORMATION IS CORRECT

I CERTIFY THAT ALL INFORMATION IS CORRECT Yes

TiECON Southeast 2012 Awards - College Student Entrepreneur of the Year

"College Student Entrepreneur of the Year" - Nomination Form