2023 Membership Application
Candidate Information
Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Phone Number
Social Media Handle
Example: @AnetteSotoLanderos
Employer
Work Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Email
example@example.com
Position
Years in Position
Have you ever been a member of H100 before? If so, why did you leave?
Biography
Please upload a high resolution headshot.
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Candidate Statements
Professional Achievement and Leadership (300-word maximum)
.Please share how your personal, professional or social/civic leadership has made a significant impact in your community or business at the local, state and/or national level.. Please list any awards, recognition, or other information you would like to be considered with your application. Also list any participation in your industry events.
Board y/o Commissions participation (200-word maximum)
Please share your participation in any boards or comissions; your role and for how long.
Community Involvement (300-word maximum)
Please share how you currently impact and/or plan to make an impact in your community – this can be through personal, professional or social/civic engagement
Why do you want to join Hispanic 100?
Please share why you are interested in joining the Hispanic 100 and how you plan to contribute to our mission.
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Candidate Signature
Sponsor Statement
H100 Sponsor Name
Sponsor Phone/Cell Phone
Sponsor E-mail
Relationship to Nominee
Please describe your association with the nominee (personal, professional, social, referral, know them by reputation) and level of exposure (long-time colleague, recent connection, etc.)
Sponsor Statement (300-word maximum)
Please state whyyou recommend the nominee for membership and how you believe they willcontribute to our mission.
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