Breakfast Nomination Form

2021 North County Incorporated Annual Leadership Awards Nomination Form

DEADLINE: FRIDAY, APRIL 9, 2021

At the North County Incorporated Annual Breakfast on Friday, September 17, 2021 we will present awards to those individuals who have shown a strong commitment to the North St. Louis County region through their business, civic and/or humanitarian acts. We need your help to identify these key individuals, businesses, and organizations. Please complete and return the following information:

Awards will be presented in five categories:

Business Development Award: An individual, organization, or business whose efforts positively impacted the economic development and business climate of the North St. Louis County area.

Community Development Award: An individual, organization, or business whose efforts positively benefited youth, residents, civic organizations or others through selfless acts. Their contributions are beyond the individual’s employment responsibilities or a business/organization’s mission and scope of work.

Elmer Belsha Leadership Award: An individual whose long-term commitment to North County Incorporated and the North St. Louis County area has had a substantial positive impact.

Diversity and Inclusion Award: Recognizes individuals or organizations showcasing exemplary dedication to diversity and equity initiatives while promoting a culture of inclusion.

Public Service Award: An outstanding individual elected, appointed, or employed by a public body whose long-time service has had a positive impact on the community and/or public body they serve.

NOTE: The individual nominated must reside, own or work for a business, organization or institution located or working within the North St. Louis County region. Nominees must be at least 18 years of age, and nominations must be submitted no later than Friday, April 9, 2021. Incomplete applications will not be considered.

Please use the form below to submit your nomination:

    NOMINATION FORM
    PLEASE FILL OUT THE FOLLOWING INFORMATION ABOUT YOURSELF:
    NAME*:

    EMAIL*:

    PHONE*:

    ADDRESS*:
    CITY*:
    STATE*:
    ZIP CODE*:

    PLEASE FILL OUT THE FOLLOWING INFORMATION ABOUT THE PERSON YOU ARE NOMINATING:
    NAME*:
    CATEGORY SELECTION:

    EMAIL:

    PHONE:

    ADDRESS*:
    CITY*:
    STATE*:
    ZIP CODE*:

    DESCRIPTION OF NOMINEE'S CONTRIBUTION TO SELECTED CATEGORY
    Please send bio and any necessary attachments to gsteidle@northcountyinc.com
    :


    Please copy the code below:
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    North County Incorporated

    350B Village Square Drive
    Hazelwood, Missouri 63042
    phone: (314) 895-6241
    email: nci@northcountyinc.com

     

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