Impact Award Nomination Form

Award recipients will be scored and selected based on the following judging criteria:

Entrepreneurial spirit
Value creation
Impact
Sustainability

Nominator First Name*

Nominator Last Name*

Nominator Email*

Company email address preferred.

Nominator Phone*

Nominee First Name*

Person you are nominating for the award.

Nominee Last Name*

Person you are nominating for the award.

Nominee Email*

Person you are nominating for the award.

Nominee Phone Number*

Person you are nominating for the award.

Commitment*

Please select which accurately describes the nominee's time commitment to this company.

This is a full-time job

This is a part-time job

Short Biography*

Please include why this individual deserves this award and examples of impact they've made in their community.

Location*

Select or enter value

Please include LinkedIn URLs for nominee and any other co-founders

Company Name*

Company URL

Other Company Social Media Links

Company Address*

Please include the full mailing address for your company.

What year was your company founded?*

How many employees does your company have?*

Gross revenue generated over the last 12 months ($USD)*

Please provide a brief description of the company.*

Examples of what to include: What does the business do, what is the business model, any IP, expertise of the leadership team, traction achieved to date (customer discovery completed, accelerators, grant funding, investment raised, strategic partnerships, etc.)?

Describe the impact created*

Examples of what to include: What problem does this company address? How is impact defined? How big is the impact both qualitatively and quantitatively? Alignment to any SDGs?

Describe the future and 5-year outlook of this company.*

Examples of what to include: Specify technology development plans, market expansion plans, fundraising, strategic objectives, and market trends that indicate future demand and growth.

Anything else we should know?*

Relevant links

Please include any other links that illustrate the impact of your company.

Supporting Documentation

Please provide any supporting documentation and/or references that can support the claims made in this nomination form.

Drag and drop files here or

Terms and Conditions*

1. The submission deadline is 30 September by midnight ET.

2. Self-nominations are NOT accepted.

3. The nominator and the nominee cannot be a member of the IEEE Entrepreneurship Awards Committee or a member of the IEEE Entrepreneurship Steering Committee.

4. The IEEE Entrepreneurship Impact Award Recipient must be willing to join the IEEE Entrepreneurship Community and provide IEEE with updates on their entrepreneurial journey.

5. Nominations must be made in English.

6. I affirm that the details and documentation provided in this nomination form are accurate and relevant.

7. Submissions with supporting materials and references provided to strengthen the claims made in the nomination form will be given priority in the evaluation process.

8. The focus should be on the a broad impact made on the entrepreneurial ecosystem. Not on professional or technical achievements.

9.Before submitting this nomination form, I have confirmed that the nominee meets the Impact Award criteria outlined on the IEEE Entrepreneurship website.

I have read and agree the Terms and Conditions.

I have read and accept the IEEE Privacy Policy

Code of Ethics*

I have read and accept the IEEE Code of Ethics

Send me a copy of my responses

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