Hispanic Leadership Awards Individual Application

IMPORTANT ELIGIBILITY NOTE: To be eligible for this award, the nominee must live or work in the state of Maryland. If the nominee is not employed in Maryland, they must show a significant impact on Maryland through community work and mentoring. The nominee must be of Hispanic descent.

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Honoree Name (as you would like it to appear in print and on an award)*

First Middle Last

Please spell out the pronunciation of your whole name (for announcing on stage during awards ceremony)*

For example: "Jay-Cubs" for "Jacobs"

Position Title*

Company/Organization*

Please type the name of your company as how you would like to see it in print

Address*

Street Address Address Line 2 City State ZIP Code

County Employed In*

Phone number, including area code*

Preferred Email Address*

If there is another email address that should be included in communications about this event, include it here.

LinkedIn Profile URL

(e.g. http://www.linkedin.com/profileview?id=1234567)

Please upload a high-resolution headshot. (This may be used in the awards ceremony or publication.)*

Please ensure that your photo(s) are no smaller than 1 MB in size. Email [email protected] with any issues.

Accepted file types: jpg, png, Max. file size: 8 MB.

Please select the appropriate category:*

Please provide a brief biography (300-400 words):*

Education: List most recent first and include degree, institution and year graduated*

Career History: List most recent and include start an end year, company and title*

Example of Mentoring*

Please give ONE example that demonstrates how you have mentored others outside of the guidance you provide to your direct reports.

Officer/board membership in professional organizations (Include volunteer and career-related organizations): Limit to past 10 years, list most recent first and include year, position held and organization*

Awards/Honors*

What awards have you been most proud to receive? List most recent first and include Year, Award/Honor Name and Awarding Institution

Leadership and Vision*

Describe ways you have helped the Maryland business community grow and how you continue to champion your industry through professional creativity, innovation and leadership.

Birthdate (mm/dd/yyyy)*

Age requirement is strictly for application process only and will not be promoted.