2021 Impact-Makers To Watch™ Nomination Form

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Complete this form by December 15.

For complete details about Impact-Makers To Watch including nomination criteria and terms and conditions, please refer to the Nomination Guide (https://bit.ly/32PKduM) and Frequently Asked Questions (https://bit.ly/3lGTT2d).

You can nominate yourself, a colleague, or other community member you admire in any of the 12 categories below. Up to three winners will be selected in each category.

You can nominate more than one Impact-Maker, but you must complete a separate form for each person you nominate. A PayPal link to pay the $40 submission fee will appear in the confirmation pop-up after you submit your entry. Submissions will be considered only after the submission fee has been received.

Thank you for your nomination!

Your first name *

Your last name *

Your title *

Your affiliation *

Your email address *

Your phone number *

Nominee first name *

If submitting yourself, please re-enter your own information

Nominee last name *

Nominee title *

Nominee affiliation *

Nominee email *

Nominee phone number *

Nomination Category *

Arts and Culture: Advocating for visual and performative expressions that help innovate, reimagine and transform the arts and cultural sphere toward success.

Early Childhood Development: Advancing high-quality early learning for all children, birth through age 8 and promoting health in early childhood.

Economic Development: Advancing opportunity and prosperity for communities by fostering the growth of well-paying jobs in key industries and preparing communities for opportunities.

Education: Leading to improve education for any stage of learning from early education to higher education and beyond.

Government Service: Leading civic agencies and offices in serving constituents and engaging the public in policies that benefit communities.

Homeless Services: Providing services to our unhoused neighbors through advocacy, philanthropy, or public policy.

Job Training/Workforce Development: Creating job training and career opportunities to build a strong and committed workforce, sustainable neighborhoods, and economic stability throughout Los Angeles communities.

Mobility: Working to utilize urban planning and policy advocacy to champion mobility justice within transportation equity policy and planning.

Resilience Building: Working to increase community resilience and connectivity in advance of catastrophic events to save lives and reduce recovery costs through community engagement, regional collaboration, reducing resident vulnerability, or capacity building for staff and elected officials.

Sustainability: Integrating environmental health, social equity and economic vitality in order to create thriving, healthy, diverse, and resilient communities.

Youth Advocacy/Services: Ensuring wellbeing and a bright future for young people in our communities through academic, athletic, or civic excellence.

Other:

Required

If you responded "Other" to the Nomination Category, please explain how your nominee doesn't fit the other 11 categories.

Please provide a link to your nominee's organizational biography page or LinkedIn Bio. *

Summary Nomination: In 150 words or less, tell us what makes this individual an Impact-Maker to Watch? (Your answer will be used as-is in printed and digital materials, so make sure you would want people to read it) *

Past Success: Tell us about three of the individual's accomplishments that exemplify the work of an Impact Maker to Watch. This is an opportunity to illustrate the effectiveness of the nominee’s leadership and vision. *

Projected Projects: Impact Makers have or are set to release plans for how they will make a difference in the coming year. What have they been working on that will really see results in 2021? *

Impact Forecast: Who will benefit from the Impact Maker’s work in 2021? Who is the target demographic, where do they live, and how many people will be impacted? A deeper impact on fewer individuals can be as important as more simple impacts on a lot of people. *

I agree to the Impact-Makers To Watch Terms and Conditions: Nominations cannot be submitted without acceptance of the Terms & Conditions below. IMPACT-MAKERS TO WATCH and IMPACT-MAKERS TO WATCH 2021 are trademarks of Stratiscope for purposes of conducting the 2021 Impact-Makers To Watch. All information, materials, functions, logos, and other content contained on the Stratiscope site are the copyrighted property of Stratiscope. No Stratiscope trademark or copyrighted material may be used, reproduced, transmitted, distributed, or otherwise exploited in any way without the express written consent from Stratiscope. Violators will be fined to the extent allowed by law. Use of Impact-Makers To Watch advertising and publicity: If you or your nominee is selected as an Impact-Maker To Watch, you authorize Stratiscope to use your image to promote the Impact-Makers To Watch list and events. For purposes hereof, the term “use” includes but is not limited to any reproduction, photograph, illustration, film, video, digital reproduction, or other depiction of your image or logo, packaging, and trademark. Stratiscope’s Rights in the Trademarks: You acknowledge that the Impact-Makers To Watch Trademark is the exclusive trademark of the Stratiscope and its licensors. You agree not to apply for or obtain registration of the Trademarks for any goods or services in any jurisdiction, nor use the Trademarks or any name or mark confusingly similar to the Trademarks as a company, business, trade, or brand name in any jurisdiction. *

Yes. I agree to these terms and conditions.

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