Nomination Form

17�Թ��25

Please fill out the below form to submit nomination for 17�Թ��25.

COMPANY NAME ( COMPANY MUST HAVE BEEN IN BUSINESS GREATER THAN 5 YEARS )

ADDRESS

CITY

STATE

ZIP

YEAR FOUNDED

WEBSITE

PLEASE EXPLAIN WHY THIS COMPANY DESERVES RECOGNITION AS A HIGH IMPACT, BUSINESS OWNED AND OPERATED BY A 17�Թ�� ALUMNUS/AE

NAME AND TITLE

GRADUATION YEAR

EMAIL ADDRESS

PHONE NUMBER

NAME

COMPANY AND TITLE

EMAIL ADDRESS

PHONE NUMBER