Nominee’s Name:



Nominee’s Name: FORMTEXT ???? ?Name of Business: FORMTEXT ?? ???Title/Position: FORMTEXT ??? ??Business Address: FORMTEXT ??? ??Home Address: FORMTEXT ?? ???Telephone: (Business) FORMTEXT ???? ? (Fax) FORMTEXT ??? ?? (Home) FORMTEXT ?? ???E-mail address: FORMTEXT ?? ?? NAICS Code: FORMTEXT ??? ??Sponsor’s Name: FORMTEXT ?? ??Title: FORMTEXT ??? ??Business/Organization: FORMTEXT ??? ??Address: FORMTEXT ??? ??Telephone: FORMTEXT ??? ?? (Fax) FORMTEXT ?? ?? E-mail: FORMTEXT ??? ??Give a brief one-paragraph description of the nominee’s business: Give a concise statement clearly describing why the nominated individual should be recognized with this SBA Small Business Award:date and Type of SBA Assistance: FORMTEXT ??? ? (Please note: SBA Assistance is not required for a nominee to be eligible for this SBA Award Category.)SELECTION CRITERIA FOR SBA FAMILY-OWNED SMALL BUSINESS OF THE YEARNominations will be evaluated by the following criteria:SELECTION CRITERIA FOR SBA FAMILY-OWNED SMALL BUSINESS OF THE YEARNominations will be evaluated by the following criteria:I.Evidence of success as measured by sales and profits. Please include gross revenues for the past three years:201120122013(Profit and loss statements and balance sheets for the past three years will be required from the State winner.)201120122013Total AssetsTotal LiabilitiesRevenuesE.B.I. WorthComments:II.Increased employment opportunities for family members and non-family members for the nominee’s business.III.demonstrated potential necessary for long-term business success and economic growth. IV.Voluntary efforts to strengthen family-owned businesses within the community.Additional InformationThe prestigious Small Business Awards honor the outstanding small business men and women who demonstrate excellence and achievement. All nominees and nominees’ businesses must comply with state and federal regulations regarding labor, immigration, civil rights, taxation, and other applicable regulations. Any financial information provided as required for the nomination will be held in strict confidence by the selection committee and SBA. By submitting the completed nomination form, the nominee certifies that, to the best of his/her knowledge, the information provided is correct and the business has complied with regulations, as stated above.Please note that SBA will accept only one nomination per person or business entity within an award category. If a duplicate nomination is received, the nomination submitted to GBO at the earliest time will be considered for the award. Individuals and businesses may only be nominated in one award category each year. SBA winners who were honored in this award category prior to the 2010 awards (more than five years ago) may be nominated if they continue to meet all criteria for eligibility for the award. A Family-Owned Small Business of the Year will be selected from qualified candidates. At least two headshot/portrait-type colored photo images of the winner, their business operation, and at least one photo with/of their nominator will be required for publicity and the Awards presentation. The photos may be in hard copy or digital format. These items will be due in the Branch Office in early February 2015.For internal use only:Received at SBA Branch Office on ______________ by ___________________.(Date)(Staff)Sponsor Signature(s):__________________________Date___________ _______________________Date____________Sponsor SponsorNominee Signature(s):__________________________Date___________ _______________________Date____________Nominee Nominee__________________________Date___________ _______________________Date____________Nominee NomineeFor internal use only:Received at SBA Branch Office on ______________ by ___________________.(Date)(Staff)Sponsor Signature(s):__________________________Date___________ _______________________Date____________Sponsor SponsorNominee Signature(s):__________________________Date___________ _______________________Date____________Nominee Nominee__________________________Date___________ _______________________Date____________Nominee Nominee ................
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