2024 Super 60 Submission Form - Give Back

Recognizing businesses that have focused on giving back to the community. This includes donations of products, services, or projects supporting non-profit organizations or local communities within Hampden or Hampshire County.

ELIGIBILITY FOR GIVE BACK AWARD

Independent and privately owned companies
Based in Hampden or Hampshire Counties.
The nominating organization is responsible for the completion of this form and for informing company of nomination if not self-nominated.
The selection for this award will be made by a committee placing emphasis on community impact and employee engagement.

Fields marked with an * are required.

Nominee Information
Tell us about the Organization you are nominating.

Name of Organization Being Nominated *

Year Founded

Product/Service *

What product or service does this organization provide?

Address Line 1 *

Address Line 2

City *

State *

Postal Code *

Nominee Organization Description (100 character limit)* *

*will be included in the Super 60 event program if selected as a winner.

Nominee CEO/President Information
Tell us about the CEO/President of the Organization you are nominating (please specify in the Title field if this somebody other than the CEO/President).

First Name *

Last Name *

Title *

Email *

Phone *

Submission Information

The Company/Organization your Company helped *

Estimated dollar value of the donation *

The Second Company/Organization your Company helped. *

Estimated dollar value of the donation *

The Third Company/Organization your Company helped.

Estimated dollar value of the donation *

Kindly provide any additional pertinent details regarding the community service *

Kindly provide any additional pertinent details regarding the community service that you believe would hold significance for our committee's consideration.

20MB max

Nominator Information
Tell us about yourself.

Nominator Name *

Nominator Company *

Nominator Title *

Nominator Email *

Nominator Phone Number *

2024 Super 60 Submission Form - Give Back

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Springfield Regional Chamber