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Nomination Form

Nomination Form

WHEN: FRIDAY, MARCH 22, 2018
NOMINATION DEADLINE: FRIDAY, JANUARY 26, 2018

Step 1 of 2

READ HERE BEFORE BEGINNING
Thank you for your interest in nominating an outstanding individual for award at the upcoming Minority Achievers Awards and Scholarship Gala. In addition, nominators should be prepared to upload a photo prior to submitting the nomination. Please read the below statement and agree prior to proceeding.
I understand that as a nominator, neither I nor my nominee will be informed of their award recipient status until the evening of the awards when such information is made available to the public.*

Select an Award Category
*
Please consider nominating someone who has made outstanding contributions in one (or more) of the categories listed below. All nominees are also considered for CLD’s two Distinguished Achievement Awards: the Accomplished Achievement Award and the Mme. C. J. Walker (Outstanding Woman of the Year) Award, respectively. Recipients of these two awards will be made public prior to the event. Note: due to the virtual nature of this year's Awards Gala, we have lessened the number of categories for consideration. We will return to the full menu in 2022.
- Achievement in Business & Industry
  All business categories except the other categories in this list
- Achievement in Education, K-12
  Public or Private Education (Teachers, Principals, Administrators)
- Achievement in Education, Postsecondary
  Public or Private Higher Education (Faculty, Staff, Administrators)
- Essential Worker
  Essential workers are those who have shown extraordinary resilience amidst a global pandemic and are critical to infrastructure operations (law enforcement and public safety, food agriculture/production/service, health care providers and emergency personnel, transportation, energy)
- Lifetime Achievement
  Recognizes contributions over the whole of a career, rather than or in addition to single contributions.
- "Up & Coming" Achiever
  Recognition of talented individuals who show the promise of achievement and are age 35 or younger
Information About Nominee
Name of Nominee:*
Prefix First Last
Nominee E-mail:*
Nominee Phone:*
Professional Title:*
Corporation/Organization/Institution:*
Home or Business Address:*
Street Address Address Line 2 City State ZIP Code
Information About Nominator
Nomination Submitted By:*
First Last
Nominator E-mail:*
Nominator Phone:*
Job Title:*
Corporation/Organization/Institution:*
Home or Business Address:*
Street Address Address Line 2 City State ZIP Code
Additional Information
Educational Background*
(Include schools, degrees, and years earned)
Employment History*
(Include employers, position title, and years at each position)
Professional Accomplishments*
Describe how your nominee has made an outstanding contribution that changed his or her workplace or profession.
Community Contributions*
(Include organizations, positions, and years held.)
In Summary*
Identify one or two activities, which may be included above, that characterize your nominee's community spirit, determination and leadership. Explain how the nominee's involvement in these activities has affected the organization and the community at large.
Upload Nominee Picture*
Drop files here or

Accepted file types: jpg, png, pdf.
Additional Documentation
Attach articles, references, and other documentation to support your nomination here.
Drop files here or
Phone
This field is for validation purposes and should be left unchanged.