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Qualtrics Survey Software ROTARY RESPONSIBLE BUSINESS AWARD
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Submission Deadline: Friday 29 July
In keeping with the international community's current conversation about the need for
inclusive economic development and in recognition of the important role that businesses
play in advancing economic conditions around the world, Rotary will honor six individual
Rotary members and two business partners with our first Rotary Responsible Business
Award during Rotary Day at the United Nations on Saturday 12 November 2016.
These distinguished individuals and companies will be honored for their commitment to using their time, material resources and hands-on assistance to address social and economic challenges locally or internationally. Districts have the opportunity to nominate one Rotarian candidate and one business partner from their district that meet the recognition criteria.
• Nominees must be current Rotary members or Rotaractors.
• Nominees should either be a business owner or have found an innovative way to engage their private sector employer in their Rotary service project(s). • Nominees should have an exemplary record of volunteer service. Ideal candidates will be involved in activities beyond fundraising.
• Nominees should be known in their community as a reliable go-to person, willing volunteer, and good citizen who enriches Rotary and her/ his community through service.
• Nominees should be involved with projects that are currently active or concluded no earlier than June 2015.
• Individuals previously honored as "Women of Action," "Rotary's Global Women of Action" or "White House Champions of Change" are not eligible for this recognition.
• Nominees must be available to attend, at no cost to Rotary, Rotary Day at the United Nations on Saturday 12 November 2016 Qualtrics Survey Software • Nominated projects must demonstrate a measurable, positive impact on the economic situation in a local or international community though: • Economic and community development• Job training/skills enhancement• Microcredit/microfinance• Entrepreneurship • An ideal project should serve as an example of: • Good collaboration/partnership with other outside organizations including one private enterprise (local businesses, corporations, schools, etc) • Commitment to support social business, startups or entrepreneurship training• Innovative thinking/implementation or creative use of technology • Nominees' projects must include participation and support of Rotary clubs/districts or The Rotary Foundation.
Business Partner Eligibility:
• Nominated business partners should be private firms that have partnered with a Rotary club or district with a commitment to support the project through a mutually agreed-upon time frame or, ideally, to its completion.
• The business partner should have a representative who can attend, at no cost to Rotary, Rotary Day at the United Nations on 12 November.
Business Partner Criteria:
• Actively supported a Rotary project in 2014-15 or 2015-16 Rotary years that made a measurable, positive impact on the economic situation in a local or international community through: • Economic and community development• Job training/skills enhancement• Microcredit/microfinance• Entrepreneurship • Exhibits a long-term commitment to supporting volunteer or humanitarian activities in the local community or around the world.
• Provided technical expertise, financial or material resources, or hands-on assistance in support of the project goals.
• Each district can submit two candidates, one individual Rotarian/Rotaractor and one business partner for consideration for this recognition.
• All nominations will be read by at least two reviewers. A special panel appointed by the Rotary President will review the semi-final nominations and select six Rotary members and two business partners as honorees.
Qualtrics Survey Software • Honorees and their districts will be notified of their selection in mid-September. Click the forward arrows ">>" below to continue
Completing the Nomination
• Complete the nomination form - Please note that the link provided is unique to each district and should not be shared with Rotarians in other districts.
• This electronic nomination form can only be submitted once.
• A preview version of the form can be downloaded by clicking this link: Rotary Responsible
Business Award Nomination Form
• You may share the preview form with clubs in your district.
• The preview form cannot be submitted for consideration.
• Only the online form will be accepted for consideration.
• Please ensure that your form is complete before making the final submission.
• You will not be able to make any changes to your form once submitted.
• This link will no longer function once your district's form has been submitted.
• Submission of the form denotes approval by the district governor.
• Upload a copy of your nominee's resume and a photograph with a clear head shot.
• Send any supplemental materials via email to ResponsibleBusiness@rotary.org
• Please do not send any materials via post.
• All nominations must be submitted to Rotary no later than Friday 29 July.
• Nominations submitted after the deadline cannot be accepted.
NOTE: This form automatically saves all changes to the document. There is no "save
button." The form will save all changes made before the survey window closes. You can
continue to make changes until you make your final submission to Rotary.
Click the forward arrows ">>" below to begin your nomination form.
Nominee General Information
Qualtrics Survey Software Primary Telephone Number Rotary or Rotaract Club Sponsoring District Number Please upload a photograph with a clear head shot. (file size must be less than 16 MB). Note: If you are using the Firefox browser, you may not be able to upload files. Please complete the survey in Internet Explorer or Google Chrome. Please upload the nominee's resume/CV as a Microsoft Word document or PDF. (file size must be less than 16 MB). Note: If you are using the Firefox browser, you may not be able to upload files. Please try completing the survey in Internet Explorer or Google Chrome. Why should this Rotarian/Rotaractor be honored with Rotary's Responsible Business Award? Has this nominee ever been honored/recognized for his/her volunteer work by an organization other than Rotary?




Qualtrics Survey Software Please provide specifics about those honors (Name of organization, dates awarded, reason etc.) Has this Rotarian received any media attention for his/her volunteer work inside or outside of Rotary? Please specify name of media outlet, date of article, reason for article.
Is the nominee active on social media (Twitter, Facebook, Google+, Instagram etc)? Please provide social media screen names/handles/addresses Signature Project



Qualtrics Survey Software This section will ask for information about the signature Rotary project in which the nominee has taken a leadership role.
Project General Information
Project State/Province Does this project have any connection to the polio eradication initiative? Is this project ongoing? When did the project end? (month/day/year) What was the humanitarian challenge or issue that needed to be addressed?



Qualtrics Survey Software How did the project address the community's need? Who participated in the project (Rotary clubs/districts or partnering organizations such as churches/ houses of worship, schools, other non-governmental organizations, local/state/national government, and business)? How much money was spent on this project? Amount in US Dollars Did this project receive a grant from The Rotary Foundation? Does this project have a website? Please provide a link to the website.
Qualtrics Survey Software Has this project received any local, national or international media attention? Please provide a link to the article(s) Would you like to nominate a business/corporate partner for their support of a Rotary project? Business Partner General Information
Business Partner Contact
Qualtrics Survey Software Please describe how this company has supported your Rotary project.
How long has this partner supported your project? Has this company helped to promote your project? Please describe how this company has promoted your project.
Has the business partner made a financial contribution to the project? How much has been contributed? (in US Dollars) Qualtrics Survey Software Has this business partner been involved in other socially responsible/humanitarian activities in your community or around the world? Please elaborate.
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This completes the Rotary Responsible Business Award nomination form.
By clicking the forward arrows below you are certifying that these nominations have been approved by the district governor.
Please remember that this form can only be submitted once. Once you click forward your nominations will be sent to Rotary External Relations. This will deactivate your web-link and you will no longer be able to make changes to the form. Once submitted, a copy of your nomination form will be displayed for your records.
If you have any supplemental materials that you would like included with your nominations, please email them to Rotary External Relations at ResponsibleBusinee@rotary.org.
ONLY CLICK THE FORWARD BUTTON IF YOU ARE READY TO SUBMIT THESE NOMINATIONS
FOR CONSIDERATION. YOU WILL NO LONGER BE ABLE TO MAKE ADDITIONS OR CHANGES

Thank you for your time and good luck to your nominees!

Source: http://www.rid3470.org.tw/upload%5C%E5%85%AC%E6%96%87%E7%AC%AC007%E8%99%9F_%E9%99%84%E4%BB%B6-Nomination_Form_EN.pdf

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