2019 IE Awards Nomination Form
RequiredRequired Question(s)
LCCC invites the nomination of individuals, teams, or organizations that have made significant impact operating in the areas of diversity, inclusion, and equity. Presentation of the Trustees of Inclusive Equity (I.E.) Awards will be made on June 18, 2019  at a special Juneteenth Celebration Gala; recognizing the results of individuals and/or teams who influence consideration and advancement of all people. 

Please complete this form by completing each section below to submit your nomination.

Nominations accepted until April 6th.

 
Required 1.
Please indicate whether your nominee would qualify for I.E. Award consideration as an individual/team/organization making a significant impact in areas of diversity, inclusion, and/or equity in one of the following categories: (choose one)

A company with more than 1,000 employees.
A company with 500-1,000 employees.
A company with under 500 employees.
Education--public & private schools, colleges and universities.
Health care, medicine or related services
A nonprofit or community setting.
Required 2.

In the box below, please state the following information about your nominee:

NAME:

TITLE:

ORGANIZATION:

ADDRESS:

PHONE;

EMAIL: 

 

350 characters left.
Required 3.
INCLUSION: Describe ways your nominee has impacted the consideration and inclusion of people for opportunity in the workplace, business and/or community affairs?

Type "n/a" if you are unaware or not sure.
 

1000 characters left.
Required 4.
EQUITY: Describe how your nominee has been successful as a leader or advocate for creating access and economic advancement within the business world or in the community they serve. (1000 characters or less)

Type "n/a" if you are unaware or not sure.
 

1000 characters left.
Required 5.
DIVERSITY: Describe what impact your nominee has made toward promoting awareness of individual contributions: regardless of race, religion, gender, sexual preference or ethnic background. (1000 characters or less). 

Type "n/a" if you are unaware or not sure.
 

1000 characters left.
Required 6.

What three (3) words best describe your nominee?

 

50 characters left.
7.
Additional comments?
 

1000 characters left.
8.
Please enter the name and contact information of the individual making this nomination.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code: