WMWITA Nomination Form 2019

Please fill out the form to nominate yourself or somebody else for the Midlands Women In Tech Awards 2019.
Please note nominees must either be from the Midlands, work in the Midlands or make a contribution to the Midlands.
  • Your Information

  • Nominee Information

    Please fill out your nomination details accurately as this information will be used to process the application. if you feel that some sections are not relevant, please provide as much detail as possible as to why you (or your nominee) should be considered for the award.
  • Please enter your full name or that of the person you are nominating
  • Please enter a valid contact number, this will be used to contact the nominee during the process.
  • Please enter the area where the nominee lives/works.
  • How long has the business/person been established for?
  • Please enter a valid email, this will be used to contact the nominee during the process.
  • Please enter the name of the Business or organisation you are nominating
  • Please select one category
  • Please give a brief overview to the nominee’s company/organisation including a description of what it does, number of employees, annual turnover and how long it has been running. (The desirable number of words is from 50 to 200)
  • Please provide a bio or brief overview of the nominee's career path to date and their role within the current company/organisation (include key responsibilities, how long they have been in the role etc). (The desirable number of words is from 50 to 200)
  • (The desirable number of words is from 50 to 200)
  • Please enter the achievements of the person or business you are nominating. Provide tangible/measurable evidence of the nominee’s success. This could include items such as % increase in sales, % increase in staff retention/performance, increase in efficiencies, new systems introduced that have led to better performance, personal achievements that have led to measurable success within the organisation and/or made a positive impact on society. For software engineers this could include things like a patent filed, benchmarking or engineering papers). (The desirable number of words is from 50 to 200)
  • (The desirable number of words is from 50 to 200)
  • (The desirable number of words is from 50 to 200)
  • Please enter any additional information, which could help your nomination to be shortlisted
  • Upload a high resolution logo for the company nominated or a high resolution picture of the person nominated.