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Minority Enterprise Development (MED) Week Awards Nomination Confirmation

Minority or Woman-Owned Business Award Nominee Confirmation Form 2023

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BUSINESS INFORMATION

Name of Owner

First Last

Name of Business

Date Established

Primary Business Activity

Address

Street Address Address Line 2 City State ZIP Code

Phone

Which category do you wish to be considered?*

Are you applying as a Minority Owned, or Woman Owned Business?

Which award do you wish to be considered for?*

Construction, Manufacturing, Professional Service, Retail, Service, Supplier/ Distributor, Young Entrepreneur, Business Advocate and Corporation of the Year.

What is the business' industry?

Construction, Manufacturing, Professional Service, Retail, Service, Supplier/ Distributor

A) Provide background information about the business and owner(s). (45 points maximum)

Owner Details

Owner's Name

Title

Percentage Owned

Ethnicity

Gender

Describe how the owner started the business. What inspired the owner to open the business and what steps were taken to establish the business, i.e. classes, research, experience? Were there any obstacles that had to be overcome?

Describe the owner's initial investment to acquire the business.

What is the impact your business has had on your community? Are there any other businesses in the area that offer this service of product?

B) Describe the current financial condition of the business by providing the following information. (35 points maximum)

What is the average gross receipts for the company over the last three years? (information used for rating purposes only and will not be shared with the public.)

Please select the amount that closely reflects the total average gross receipts.

What was your yearly percentage of profit to revenues?

For Fiscal Year 2021

What was your yearly percentage of profit to revenues?

For Fiscal Year 2020

What was your yearly percentage of profit to revenues?

For Fiscal Year 2019

Provide employment (job creation) history of the business for the past three years. For example, how many employees were needed to open the business? How many are currently employed by the business? Full-time, part-time?

Describe the impact of the business' job creation on the community.

What future goals does the owner have for the business?

C) List trade organizations and community involvement of the business and its owner(s). (10 points maximum)

D) List relevant awards received by the business and/or business owner(s). (5 points maximum)

E) Attach any additional information that you believe to be pertinent to the selection process (i.e. written articles, awards received.) (5 points maximum)

Young Entrepreneur Nomination Confirmation

A) Provide background information about the young entrepreneur. (30 points maximum)

Describe how and when the entrepreneur started the business.

What inspired the entrepreneur to open the business?

What steps were taken to establish the business, i.e. classes, research, experience?

Discuss any major obstacles that have been overcome by the young entrepreneur.

What future goals does the entrepreneur have for the business?

B) Present a description of the current financial condition of the business.

(30 points maximum)

How much revenue has the business generated in the past year?

How many employees does the business currently have?

Who is the target market for the services or products provided by this business?

Describe the impact the business has had on the community, schoolmates and the young entrepreneur. (30 points maximum)

Please provide any additional information you believe to be pertinent in selecting this person for the Young Entrepreneur Award (i.e. articles, written, awards received) (5 points maximum)

Business Advocate Information

Name of Advocate

Name of Business

1) Describe your professional and/or business background. (10 points maximum)

2) Describe how you or your company has worked on behalf on minority or women owned business. (45 points maximum)

3) Describe the impact your individual efforts have had on the community. (40 points maximum)

4) Provide any additional information you believe to be pertinent in the selection processes (i.e. articles written, awards received.) (5 points maximum)

Corporation of the Year

Corporations eligible for this award must be using a diversity supplier/contracting system or similar program.

Name of Corporation

1) Provide background information on the corporation. (15 points maximum)

2) Provide information on the company's minority and/or women business procurement or contracting program. (35 points maximum)

3) Provide a list (over the last two years) of the nominee's purchasing or contracting history with minority and/or women businesses. (35 points maximum)

4) List organizations to which the company belongs that may have an impact on minority and/or women business development. (10 points maximum)

5) Provide any additional information that may demonstrate the corporation's outstanding contributions in support of minority and/or minority/or women business development. (5 points maximum)

Attach Logo (Jpeg, png, pdf)

Drop files here or

Max. file size: 50 MB.

Attach Photos of Owner, Business, or Products

Drop files here or

Max. file size: 50 MB.

Request your State of Kansas Tax Clearance Form

Click here to visit the Department of Revenue Tax Clearance Site

Attach your completed proof of Kansas tax clearance (PDF)

If your tax clearance form is unavailable at the time of submission, please email the completed form to Office of Minority and Women Business Development: [email protected]

Max. file size: 50 MB.

MED Week has been celebrated nationally to recognize the more than 9.2 million minority business enterprises that support the U.S. economy and generate over $1.8 trillion in revenue. The Kansas Department of Commerce’s Office of Minority and Women Business Development holds this annual Awards program to recognize economic contributions of woman- and minority-owned businesses and communities around our state.

Awards are presented to minority and women-owned businesses in the following categories: construction, manufacturing, professional service, retail, service, supplier/distributor, young entrepreneur, business advocate and Corporation of the Year.