Exit this survey TAG Diversity Leadership Award Nominations 1. NOMINATIONS MUST BE SUBMITTED BY May 27th, 2014 Question Title * 1. Please provide the name and contact information of the individual you are nominating. *Please note that all nominees will be notified of their nomination via email. Name: Company: Address 1: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Submitter Information Question Title * 2. Describe the rationale for the nomination. Please describe how the nominee exemplifies and promotes diversity in the workplace. Focus answers on how the individual leveraged creative, intellectual, cultural, ethnic, generational, gender or lifestyle diversity. Suggested word limit – 500 words. Question Title * 3. Please provide us with your contact information. Name: * Company: Address 1: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Position/Title: Email Address: Phone Number: Question Title * 4. What is your relation to the nominee? Question Title * 5. May we reveal your name as the person making the nomination? Yes No Question Title * 6. Preferred method that we use to contact you. Phone Email Question Title * 7. When is the best time to reach you? 8am-11am 11am-1am 1am-5pm 5pm-8pm 8pm-10pm Other (please specify) Question Title * 8. Preferred method to contact the reference Phone Email Nominee Information Description of the Effort or Initiative Question Title * 9. Please describe how the nominee impacted the business and overall company morale. What exemplary characteristics does this person embody? Please include specific results in the response. Suggested word limit – 250 words. Question Title * 10. Role Nominee played in the initiative:(Check all that apply) Conceptualized Lead full initiative Managed portion of initiative Informal role but level of participation was vital to programs success Other (please specify) Question Title * 11. What was the role played in relavent initiatives? (check most appropriate response(s)) The initiative was central to the nominee's full time job Monetary compensation was tied to their responsibilities in the initiative This was volunteer involvement in addition to other full time responsibilities. Nominee had reduced regular job responsibilities in addition to responsibilities in initiative Question Title * 12. How many employees were involved in this initiative? Please indicate if the outcomes below were a result of the initiative. Question Title * 13. Increased employee morale/improved work environment Yes No N/A Question Title * 14. What was the impact of this person's work (e.g. did this person increase revenues, profits, operating efficiencies?) Question Title * 15. Increased productivity Yes No N/A Question Title * 16. Please indicate those areas where goals were met or exceeded. Increased revenues Increased profits Increased operating efficiencies Increased employee morale/improved work environment Increased productivity Question Title * 17. Nominee Reference- Please provide a reference, either a supervisor or individual with authority to speak to and validate the performance of the efforts put forth by the nominee. Please provide us with their contact information. Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Question Title * 18. Lastly, please provide the LinkedIn profile link and Twitter handle of the nominee. Thank you for your nomination! Done