Breakfast Nomination Form

2023 North County Incorporated Annual Leadership Awards Nomination Form

DEADLINE: FRIDAY, MARCH 24, 2023

At the North County Incorporated Annual Breakfast on Friday, May 12, 2023, 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:

  • The Elmer Belsha Leadership Award is presented to an individual who has a positive impact on the North County Inc. and the North County community.
  • Business Development Awards are presented to those whose efforts have positively affected the economic development and business climate of the North County area.
  • Community Development Awards are presented to those whose efforts positively benefit residents, youth, civic organizations and/or others through selfless acts.
  • Public Service Awards are presented to individuals, 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.
  • Diversity, Equity, and Inclusion Awards recognizes individuals or organization showcasing exemplary dedication to diversity and equity initiatives while promoting a culture of inclusion.

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, March 24, 2023. Incomplete applications will not be considered. A list of past award recipients can be found at www.NorthStLouisCounty.com.

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
    The judges are only given the information that you submit with this application as they consider the nominee. Please be as complete as possible and provide as much detail as possible. Remember the judges usually do NOT know your nominee. Please also submit a bio/resume/and any additional supporting documentation for the person you are nominating to jcuriton@northcountyinc.com

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    North County Incorporated

    8225 Florissant Rd., Suite 11
    St. Louis, MO 63121
    phone: (314) 895-6241
    email: nci@northcountyinc.com

     

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