1:34 PM 2/4/2010 Stoel Rives - Utah Innovation Awards 2008

Official 2010
Nomination Form

Entries are due February 10, 2010
Please completely fill out this nomination form and submit it here electronically.

You may nominate your own organization's innovation or someone else's.

If you have problems submitting this form electronically,
contact Jenn Oblad at joblad@stoel.com (801) 715-6662.

 

NOMINATION CATEGORY
(select one)

Biotechnology/Pharmaceuticals
Clean Technology and Energy
Computer Hardware/Electrical Devices
Consumer Software and Web Services
Enterprise Software and Web-Enabled B2B Solutions
Mechanical Systems/Chemicals/Manufacturing
Medical Devices
Outdoor and Consumer Products
Other*
*The "Other" category is designed for innovations that do not fit perfectly into one of the nine technology categories above.

Please note that depending on the nature and the quantity of the nominations submitted, the Selection Committee reserves the right to not recognize finalists and a winner in every category. Upon reviewing nominations, if the Selection Committee determines that a nomination would be better suited in a category other than the one in which it was submitted, the Committee may re-categorize it as it deems appropriate.


NOMINATOR INFORMATION
As the nominator, please provide your name and contact information.

Name
Title
Organization
Street Address
City
State
ZIP Code
Phone
Email

PREVIOUS NOMINEES

If you previously submitted a nomination that was not named a winner, and you would like the same innovation to be reconsidered for the 2010 awards, indicate below.

I would like the Selection Committee to review a nomination form submitted in previous years.

Name of Innovation

Please provide us with an update on the innovation. For example, substantial sales revenue, patent applications, etc.

By clicking above, the Selection Committee will review the nomination form you previously submitted. However, you will need to mail in additional background materials. If anything about the innovation has changed, we strongly recommend that you complete the nomination form below with updated information.


THE INNOVATION

Describe your connection to the nominated innovation.

Innovation Name
Please list the innovation and company name exactly as you would want it to appear on an award trophy. For example "Innovation A by Company B". Please remember hyphenation and punctuation marks and capitalization.
(50 characters or fewer)

Brief Description of Innovation
If your nomination is selected as a finalist, this brief description will be provided to the media and included in printed materials distributed at the Awards Luncheon. Please write this description for a general business audience. Avoid technical jargon.
(30 words or fewer)

Complete Description
Provide a compelling summary of the innovation you are nominating. Please write this description for a general business audience. Avoid technical jargon.

More Details About the Innovation
In the boxes below, please provide more information that will help the Selection Committee understand the significance of this innovation. If desired, you may also separately submit up to five pages of additional background materials.

The Need
What specific problem(s) does the nominated innovation remedy? How large is the market or the group of individuals who may benefit from the innovation?

Competition
List and describe the Innovation's competition.

This Innovation's Uniqueness
What makes the nominated innovation especially unusual or important? Why is it innovative in your industry?

Patent Information
If the nominated innovation has received any patents, or if any patent applications have been published, please provide details, including the identifying number(s) of the issued patent(s) and published application(s).

Financial Information (OPTIONAL)
Please provide last years revenue and net income that is directly attributable to the innovation.

Innovation References
Please list the individuals who were/are involved in the development or are familiar with the innovation. Provide each individual's name, title and contact information.

Other
Please provide any other information that will help the selection committee evaluate the innovation.

INNOVATION PHOTO AND COMPANY LOGO
Please email one or two high resolution photos and a company logo to Jenn Oblad at joblad@stoel.com (300-dpi JPEG, or eps format). The subject line of your email should read, "Innovations Nomination Photo with company name and innovation name". If named a finalist and/or winner, at least one photo will be published in the Awards Luncheon program, on media materials and the Utah Innovation Awards website.

THE INNOVATING ENTITY
Please provide the official name, address, phone number and Web address for the business or other entity that created the nominated innovation.

Entity Name
Street Address
City
State
ZIP Code
Phone
Web Site

CONTACTS AT THE INNOVATING ENTITY

Chief Executive Officer
Name
Title
Phone
Email

Selection Committee Contact
Identify the person who can provide further information if the Selection Committee has questions about the nominated entry. Fill in the "Name" box below and additional boxes only if you select the "Other" option (select one).

Chief Executive Officer
Nominator
Other (provide the name and contact information below)

Name
Title
Phone
Email

Trophy Representative
Identify the innovating entity's representative who will accept the trophy at the Awards Luncheon (select one).

Chief Executive Officer
Nominator
Other (provide the name and contact information below)

Name
Title
Phone
Email

ADDITIONAL MATERIALS

Permission to Use Materials
If our company’s innovation is selected as a finalist or winner, Stoel Rives LLP has our permission to use our company logo, innovation photo and description in program materials and on the Utah Innovation Awards website. We also grant permission to Stoel Rives to use our company logo, innovation photo and description in materials distributed to media representatives.

Name
Title

You are invited to submit additional background materials to help the Selection Committee learn more about the nominated innovation. Examples of items you may wish to include are product brochures, news articles, photographs, or diagrams. Limit these materials to five pages that can be easily inserted into a three-ring binder. At the top of each page, clearly identify the nomination category, innovation name and innovating entity name.

All additional materials should be mailed to the following:
Jenn Oblad
Stoel Rives LLP
Attention: Utah Innovation Awards
201 S. Main Street, Suite 1100
Salt Lake City, Utah 84111


The deadline for receiving these materials is February 10, 2010. Materials will not be returned.

How did you learn about the Utah Innovation Awards Program?
Association of Corporate Growth
Deseret News web site
Editorial story in local newspaper
Friend/Colleague
FundingUniverse
Internet search
Manufacturers Extension Partnership
Radio
Selection Committee member
Steering Committee member
Stoel Rives LLP
Utah Business
Utah Manufacturing Association
Utah Technology Council
Wayne Brown Institute
Other
Please Specify

Indemnification Clause
PLEASE DO NOT SUBMIT ANY CONFIDENTIAL OR PROPRIETARY INFORMATION. By checking this box, you agree that this entry does not contain, and that neither you nor the innovating entity on whose behalf you have submitted this entry (the "Innovating Entity") will submit to Stoel Rives LLP or to any of the selection committee members ("Selection Committee Members") or sponsors ("Sponsors") of the Utah Innovation Awards Program (the "Innovation Awards Program"), any information or other materials that you or the Innovating Entity deem to be confidential or proprietary. You further acknowledge and agree that any information or other materials submitted by you or the Innovating Entity in connection with the Innovation Awards Program may be used or disclosed by Stoel Rives LLP and the Sponsors and Selection Committee Members in connection with the Utah Innovation Awards Program without restriction. Finally, you and the Innovating Entity agree to indemnify Stoel Rives LLP and the Sponsors and Selection Committee Members from and against any claims, losses, damages, liabilities, settlements, attorneys' fees and any other expenses any of them may incur in connection with their use of any information or materials they receive from you or the Innovating Entity.

I Agree
I Disagree

 

This is the end of the entry form.

Before submitting your nomination, please click on the button below to review the entry as it will be given to the Selection Committee. If you would like to make changes, simply return to this page and scroll back to the portion of the entry form that you want to modify.