Please note that upon hitting submit, you agree to re-enter the nomination process for 2016. All information previously collected from you will be used in this year's judging process. Click here to read the 2016 rules and regulations.

Name (Nominee) *
Name (Nominee)
Phone Number (Nominee) *
Phone Number (Nominee)
Please describe in under 500 words.
It could be a story of when you were growing up, or perhaps an 'aha!' moment you had while working on something that matters to you. This story will be shared broadly if you are selected for the 2016 list, so please find a balance between a personal story that matters to you and one you're willing to discuss publicly.