40 Under 40 Nominations

We are now accepting nominations for the 14th annual 40 Under 40. 
Deadline for nominations: June 2, 2012
 

1. Enter Nominee Information

Nominee First Name*: 

Nominee Last Name*:

Nominee Age*:   Nominees must be younger than 40 as of Nov. 1, 2012.

Nominee Date of birth:

Nominee Gender:   Male      Female 

Nominee Address:

Nominee City:      

State:       Zip: 

Does the nominee currently live in Western Pennsylvania?: Yes No

Nominee Phone Number*:     

Nominee E-Mail*: 

Nominee Place of employment*: 

Nominee Current title:

Has the nominee been previously selected as a 40 Under 40 winner?: Yes No

2. Answer the Following Questions Thoughtfully and Carefully

PERSONAL STORY: max. 200 word summary describing the nominee's personal story • What sets the nominee apart? (e.g. unique circumstances, overcoming obstacles) • Personal anecdotes or insights about the nominee

PROFESSIONAL ACHIEVEMENT: max. 200 word summary describing the nominee's professional achievements, activities and milestones

COMMUNITY IMPACT: max. 200 word summary addressing the nominee’s community involvement • Keep in mind that particular attention will be paid to the nominee’s overall commitment to and impact on the Pittsburgh region.

ADDITIONAL INFORMATION:

3. Enter Your Information

Nominator's Name*: 

Address:

City:      

State:       Zip: 

Phone Number*:

Nominator's E-Mail*: 

How did you hear about 40 Under 40?
PUMPPittsburgh MagazineOther

* Required Fields

4. Upload Supporting Documents

Suggested documents include resume, recomendations, press releases or related articles

You may upload an attachment with your submission. We accept the following file types:
jpg,jpeg,gif,pdf,zip,doc,docx,txt