Start Up of the Year Nomination Form

Innovation Start Up of the year

This award acknowledges a Start-up company’s leadership through the innovation and development of science and/or technology and/or agriculture products, services or research; its dedication to community involvement; and potential for growth and positive impact on the community. The company must be in the 'idea' or 'discovery' stage, generate a revenue lower than $100,000, developed an innovation in the Science, Technology, Engineering or Mathematics (STEM) or Agriculture sector, benefited the community with its product/service, and be located in the Algoma region.

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* 1. Name and title of Nominee

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* 2. Name of Company

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* 3. Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 4. Submitted by:

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* 5. Submitter email

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* 6. Age of Company?

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* 7. Provide a description of the nominee's business/organization

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* 8. How has the nominee displayed a passion for science, technology and/or the technology sector?

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* 9. Is the nominee involved in the local community? Please explain

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* 10. (Optional) Please provide any URL's or links to provide supporting documentation for your nomination. You can also email (PDF's only please) to info@ssmic.com

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* 11. Please list any additional recognition the nominee has received.

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* 12. All people nominated by a peer will be contacted and given the opportunity to add to their nomination form. If you are nominating a peer you may keep your name anonymous. Please select one of the following:

I would like to remain anonymous

My name can be mentioned to the nominee