2010 40 Under Forty

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Applications Due May 21, 2010

You have been nominated for 40 Under Forty recognition.

To be considered for inclusion in the 2010 class, nominees must be under the age of 40 on July 8, 2010. All nominees are also required to complete and submit the following informational questionnaire by 5:00 p.m., Friday, May 21, 2010.

There are twelve questions, please feel free to preview the questions, complete your answers off-line then copy and paste the text in to the online form. 

We look forward to learning more about you.  It is a great honor to be nominated and is a reflection of the respect you have earned from your peers. 

** Information submitted in the questionnaire may also be used in writing nominee/honoree profiles for the event and supplement. If you would like information to be considered for judging but not for publication, please indicate your preference next to the specific answer.

Contact the Business Examiner events manager with any questions regarding the process.

APPLICANT'S INFORMATION

First Name *

Last Name *

Your Title *

Your Email *

Your Phone *

MANAGERS OR MAIN CONTACT (If different than applicant)

Marketing Manager Name

Marketing Manager Email

Marketing Manager Phone

COMPANY INFORMATION

Name *

Headquarter Address *

City *

Zip *

Phone

Fax

Web Site

COMPANY DESCRIPTION

Industry:

Main Markets:

PERSONAL STATISTICS

Birth Date: MM/DD/YYYY *

Years at Current Position * (Numbers Only)

Describe your career path. *

What have you done that has made you most proud? *

How did you earn your first dollar? *

What do you know now that you wish you would have learned earlier in your career? *

What would most people be surprised to learn about you? *

What volunteer, civic or community service opportunities are you involved with? *

What are you most passionate about? *

How would you describe success? How will you know when you've "made it?" *

Describe your perfect weekend or afternoon away from work? *

Who was your mentor and how do you plan to mentor someone else? *

What has been your biggest challenge and how was it resolved? *

What else should the local business community know about you? *

SUPPORTER CONTACT INFORMATION Additionally, please name three key vendors that have contributed to the success of your company's culture. This may be your health care insurance provider, financial advisor, attorney, consultants, or others.

Vendor 1 Vendor 2 Vendor 3 Name Contact Address City State Zip Phone E-mail Web Site

Thank you for completing the 2010, 40 Under Forty informational questionnaire.  You will be notified of the class selection after the independent panel determines the honorees.

Congratulations again on your nomination. Please contact the Business Examiner with any questions regarding the selection process.