Black 40 under 40 Award Application

Application Checklist

All required personal information and answers to the essay questions should be answered in their entirety before the “submit” button is pressed.
Email one-page resume and biography (maximum 200 words) to app@black40under40.com .
Email a high-resolution color headshot of at least 300 dpi by Nov. 1, 2020, at 12 midnight, to app@black40under40.com .
It is your responsibility to ensure all application materials have been received by the selection committee by the submission deadline of Nov. 1st, 2020, to app@black40under40.com
No additional information beyond the application form, resume, biography, headshot, will be considered by the selection committee; please be thorough with your application.
For more information or questions, email the selection committee at app@black40under40.com .

Name *

First

Last

Date of Birth

mm-dd-yyyy

Street Address

Street Address Line 2

City

State

Postal / Zip Code

Gender

What have you done in the past year to improve the Black community?

What have you done in the past year to improve the performance of your company?

What are your future personal and professional aspirations?

What do you feel makes you deserving of recognition by your community?

What leadership positions do you currently hold?

Can you give an example of how you demonstrate leadership in your profession / business etc?

What is your favorite quote?

Email *

Primary Phone

Area Code-Phone Number

Secondary Phone

Area Code-Phone Number

County of Residence

How did you hear about the Awards?

Please select one industry for which you wish to apply

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