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* 1. First and Last Name

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* 2. Email

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* 3. Contact Phone Number

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* 4. Where do you live (City/State or Province)

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* 5. Company Name

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* 6. Which of the following apply to you? Check all that apply

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* 7. Please confirm that you are a woman of color. To proceed with this nomination you must be a woman of color (defined as nonwhite women whose ethnic identities intersect with one or more nonwhite ethnic group).

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* 8. Which award category applies to you? Select one

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* 9. What is your 2023 Company revenue? (This will be kept confidential)

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* 10. I am the (select all that apply)

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* 11. What percentage growth has the company experienced in the past year? (must be a positive number)

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* 12. Please describe any give-back activities you participate in. This could include but not limited to nonprofits, foundations, mentoring, charity work, community projects and boards. Limit 400 words

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* 13. Please describe how you are making an impact in the following areas (200 words max for each):

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* 14. Please list any awards or accolades you would like to mention. 250 words max

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* 15. If you are named a winner, you must be able to attend to collect your award. Please confirm you can you attend the awards ceremony the evening of Sept. 11 in Philadelphia, PA. Please note you will not be permitted to send a representative in your place.

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* 16. Would you be interested in hearing more about any of the below offerings? (check all that apply)

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