Award Nomination Form

Charles County, MD Minority Small Business Award Nomination
Nominee Questionnaire
Name*

First NameLast Name
Business Name*
Title*
Address*
City*
State*
ZIP*
Phone*
Fax
Email*
Please provide the following information if the nomination category requires the nominee to be a women business owner:
Type of Business*
Date Business Started*

MonthDayYear
The following documents must be submitted with your nomination.
Please include a maximum of one 8.5” x 11” page describing how you meet the selection criteria, listing specific accomplishments that relate to the category for which you were nominated*

Upload a File

Cancelof
Please include a current photo*

Upload a File

Cancelof
Should be Empty:

Charles County, MD Minority Small Business Award Nomination