Innovative Startup Nominations Survey Form
Nominate and evaluate innovative startups. All responses are confidential and will be used to recognize outstanding innovation in the startup ecosystem.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Startup Name You Are Nominating
*
Startup Website (if available)
Primary Industry of the Startup
*
Please Select
Technology
Healthcare
Finance
Education
Sustainability
Consumer Products
Other
How would you rate this startup's level of innovation?
*
1
2
3
4
5
Which best describes the impact of this startup?
*
Local
National
Global
Evaluate the startup on the following criteria:
*
Rows
Excellent
Good
Average
Needs Improvement
Team Expertise
1
2
3
4
Market Potential
5
6
7
8
Scalability
9
10
11
12
Social Impact
13
14
15
16
Briefly describe why you believe this startup is innovative.
*
Would you recommend this startup for further recognition?
*
Yes
No
Submit Nomination
Should be Empty: