Entrepreneur of the Year Application Form - New Hampshire Tech Alliance

Full Name *

Email *

Phone *

Business Name *

Job Title

Business Address *

Brief Description Of Business *

Year Business Was Established

Number of Employees

Is the company publicly held? *

Yes
No

Legal Structure of Business *

Has your company/organization been the subject of any investigation by a governmental body or a criminal complaint in the last 10 years? *

No
Yes

Net Annual Sales - Most Recent Year End *

Net Annual Sales - 2nd Most Recent Year End

Net Annual Sales - 3rd Most Recent Year End

In 250 words or less, describe your entrepreneurial background including special skills, experience, major accomplishments, etc. List business, community, or civic organizations of which you are a member and the extent of your involvement. Active community participation is important in the overall evaluation process. *

In 250 words or less, describe the history of your company/organization. Include the source of the idea for the original business strategy, the financial risk involved and any other pertinent information. It is important to delineate the use of innovative approaches, management and marketing. Also, provide specific information about the company’s current stage of development and future prospects. *

In 250 words or less, describe how your company/organization is unique or innovative in its relations with (a) its employees and (b) its customers. Also, briefly describe the major products and/or services. Include the reasons your company/organization is unique and/or has demonstrated excellence in its field. *

In 250 words or less, describe your plans for the future of the company/organization which demonstrates your innovative planning skills. *

In 250 words or less, describe any other considerations that demonstrate your skills, experience, etc., including the selection of the key management team members, and detailing your experience, special skills, and major accomplishments. *

Provide specific examples of management or business successes. *

In 250 words or less, describe your sustainable development goals and plans in support of Gender Equality, Sustainable Cities and Communities and Responsible Consumption and Production. (Additional information available from The United Nations Division for Sustainable Development Goals https://sdgs.un.org/goals ) *

If I am selected for a NHTA Entrepreneur of the Year Award, I hereby authorize, in connection with the NHTA EOY Program, Innovation Summit and or the NH Tech Alliance, the use of my name, my company's name, non-financial information, likeness, photographs, video recordings, and audio recordings of me from whatever source. I agree that no compensation shall be due me or my company for such usage. *

I agree.

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Entrepreneur of the Year Application 2023