Groundbreakers Award Nomination Form
Nominator Information
Name
*
First Name
Last Name
Organization
Email
*
example@example.com
Relationship to nominee
*
(i.e. self, colleague, client, etc.)
Nominee Information
Nominee Name
*
May be individual, organization, project, or other depending on award. Please review eligibility criteria.
Nominee Email
example@example.com
Nominee Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Nominee Website
Link to Nominee Social Media
(i.e. LinkedIn)
Award Category
Select the Award you would like to submit this nomination under. Please review the eligibility criteria at https://groundbreakersconference.com/awards
Nominee Award Category
*
Please Select
Transformative Development Award
Legacy of Excellence Award
Community Leadership Award
Groundbreakers Impact Award
Emerging Leader Award
Outstanding Local Initiative Award
Tell us about the nominee.
*
0/300
Why does this nominee deserve the award selected?
*
Has the nominee made measurable impacts? If so, please list those metrics.
Please attach any supporting materials.
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(i.e. letters of recommendation, articles, photos, annual reports, etc.)
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