40 under 40 Ballot

In the January 2013 issue of Connecticut Magazine, we will be featuring the best of the best of a new generation—Connecticut's 40 leaders under the age of 40. To make sure our list truly reflects excellence, we're asking for your assistance. If you know of someone who fits this description—it could be a co-worker, your boss, a rising star in your company, firm or community—please complete the form below by Sept. 21, 2012 and send it in. We'd like to hear from you.

Nominee Information

  
Nominee Name *
Age *
Gender * Male   Female
Address
City
State
Zip  
Home Phone *  
Email *  

500 word (maximum) summary
Please address the following clearly and thoughtfully:
Nominee's professional achievements and activities • Nominee's community involvement • What sets the nominee apart? • Personal anecdotes or insights about the nominee (Keep in mind that particular attention will be paid to the nominee's overall commitment to his or her community.)
 
Additional Information  

Nominator Information

  
Nominator Name *  
Email *  
Address  
City  
State
Zip  
Daytime Phone *