Before beginning this nomination form, please be sure you have read all of the requirements for nominations, that your prospective nominee has not already been a winner in the past, and that they live or work in Berrien, Cass, or Van Buren Counties.

*1.First and Last Name of the Person You Are Nominating(Required.)

*2.Nominee's Age (Must be below age 40 before July 13, 2026)(Required.)

*3.Nominee's Job Title(Required.)

*4.Nominee's Place of Employment(Required.)

*5.Street Address, City, State, Zip of Nominee's Place of Employment(Required.)

*6.Nominee's Phone Number at Place of Employment(Required.)

*7.Nominee's Cell Phone Number(Required.)

*8.Nominee's Email Address(Required.)

*9.Link to Nominee's LinkedIn Profile (Instagram or Facebook Profile if LinkedIn doesn't exist)(Required.)

*10.Tell us about the nominee's career path and/or current position(Required.)

*11.How has this nominee made an impact at his or her business/organization?(Required.)

*12.How has the nominee exhibited any or all of the following qualities?

• Drive
• Motivation
• Forward-Thinking Attitude
• Innovation
• Community Involvement
• and/or Leadership

(Required.)

*13.What impact has this person had on his/her community? (Civic Leadership)(Required.)

*14.Tell us about the nominee's Achievements, Awards and Special Recognitions(Required.)

*15.Any further comments about the nominee?(Required.)

*16.Nominator, please tell us about you. Please note that we may mention your name as the nominator in public-facing materials and during the award ceremony if your young professional is chosen. Self-nominations will not be revealed.(Required.)

Name

Company

Title

Email Address

Phone Number

*17.Please tell us your relationship to the person you are nominating(Required.)

Send me a copy of my responses via email

1 / 1

100%