2018 TAG Diversity and Inclusion Awards Individual Nomination Form

TAG Diversity and Inclusion is committed to honoring those companies
with a Georgia presence that have demonstrated exceptional efforts to
advance diversity and inclusion within their organizations, and to
embrace the excellence of all employees – regardless of race, faith,
religion, gender, gender identity, sexual orientation, age, disability or
culture – to achieve positive outcomes in both the workplace and in
the community.

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* 1. Nominee's name and contact information (including company contact info, personal email and cell number)

Name *

Company *

Company contact info

Personal Email Address *

Personal Phone Number *

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* 2. What is the size of the nominee's company?

Start-up: the company has existed for less than one year

Small: 9-99 employees

Mid-size: 100-499

Large: 500+ employees

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* 3. With respect to our mission statement above, briefly explain how your nominee exemplifies and promotes diversity and inclusion in the workplace. Please provide any example of public (non-confidential) announcements this company may have made to promote diversity initiatives.

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* 4. Nominator's name and contact information:

Name

Company

Title

Email Address

Phone Number

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* 5. What is your relationship to the nominee?

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* 6. May we reveal your name to the nominee?

Yes

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* 7. Preferred method for contacting you.

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* 8. When is the best time to reach you?

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* 9. Briefly explain how your nominee's actions impacted their company's morale.

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* 10. What role did your nominee play in the diversity initiative within their company? (Check all that apply)

Conceptualized

Led the Initiative

Managed Portions of the Initiative

Informal role, but level of participation was vital to the initiative's success

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* 11. Was the nominee's role in addition to their full-time responsibilities within the company?

Yes

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* 12. Please try to quantify the size of the nominee's initiative in terms of the number of people who were impacted.

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* 13. Please provide any quantifiable details with respect to the impact of this nominee's initiative.

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* 14. Did the nominee's initiative result in a positive revenue impact? Please quantify, if possible.

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* 15. Did the nominee's initiative result in a positive profitability impact? Please quantify, if possible.

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* 16. Did the nominee's initiative impact efficiency within the company? If yes, please explain.

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* 17. Please describe any morale impact the nominee's initiative had on the company.

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* 18. Please provide any productivity impact the nominee's initiative had on the company.

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* 19. Please provide a reference for the nominee. The reference should be the nominee's supervisor, or a person with the authority to speak to and validate the nominee's performance.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 1. Nominee's name and contact information (including company contact info, personal email and cell number)

Question Title

* 2. What is the size of the nominee's company?

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* 3. With respect to our mission statement above, briefly explain how your nominee exemplifies and promotes diversity and inclusion in the workplace. Please provide any example of public (non-confidential) announcements this company may have made to promote diversity initiatives.

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* 4. Nominator's name and contact information:

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* 5. What is your relationship to the nominee?

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* 6. May we reveal your name to the nominee?

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* 7. Preferred method for contacting you.

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* 8. When is the best time to reach you?

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* 9. Briefly explain how your nominee's actions impacted their company's morale.

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* 10. What role did your nominee play in the diversity initiative within their company? (Check all that apply)

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* 11. Was the nominee's role in addition to their full-time responsibilities within the company?

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* 12. Please try to quantify the size of the nominee's initiative in terms of the number of people who were impacted.

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* 13. Please provide any quantifiable details with respect to the impact of this nominee's initiative.

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* 14. Did the nominee's initiative result in a positive revenue impact? Please quantify, if possible.

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* 15. Did the nominee's initiative result in a positive profitability impact? Please quantify, if possible.

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* 16. Did the nominee's initiative impact efficiency within the company? If yes, please explain.

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* 17. Please describe any morale impact the nominee's initiative had on the company.

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* 18. Please provide any productivity impact the nominee's initiative had on the company.

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* 19. Please provide a reference for the nominee. The reference should be the nominee's supervisor, or a person with the authority to speak to and validate the nominee's performance.

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* 20. Please provide the nominee's LinkedIn profile and Twitter handle (if available)