Annual Conference "The Diversity Gap: From Obstacles to Opportunities"

ICMCP^® Annual Conference

“The Diversity Gap: From Obstacles to Opportunities”
Minority Educator of the Year Nomination Form
Nomination submission period January 23 – February 15, 2017

NOMINEE CONTACT INFORMATION

Please list name, title and company/organization name as you would like to see in all print materials.

(Include phonetic pronunciation)

Data Fields with Asterisk Are Required	Enter Data In This Column
First Name*
Last Name*
Title*
Company/Organization Name* (62 character limit)
Mailing Address*(No PO Boxes)
City*
State*
Zip*
Office Phone* (Include area code and extension)
Mobile Phone (Include area code)
Email*
Assistant's Name
Assistant's Phone (Include area code)
Assistant's Email
LinkedIn profile URL
Twitter handle

NOMINATOR CONTACT INFORMATION

Data Fields with Asterisk Are Required	Enter Data In This Column
Name of Official Nominator* (if different than Nominee Information above)
Title*
Company Name*
Address*
City*
State*
Zip*
Office Phone* (Include area code)
Mobile Phone (Include area code)
Email*

PRIMARY CONTACT CONCERNING THIS NOMINATION FORM

Data Fields with Asterisk Are Required	Enter Data In This Column
Name of Primary Contact Person regarding this Nomination Form*
Title* (Complete remaining if different from Nominee or Nominator contact information)
Company Name*
Email*
Office Phone* (Include area code)
Mobile Phone (Include area code)

PUBLIC RELATIONS CONTACT FOR THIS NOMINATION FORM

Data Fields with Asterisk Are Required	Enter Data In This Column
Name of PR Contact (if applicable)
Company Name
Title
Address
City
State
Zip
Office Phone*
Mobile Phone (Include area code)
Email*

EXECUTIVE NOMINATION QUESTIONS


IMPORTANT: Only the nominee bio and headshot photo will be included on the ICMCP® Programs website and in promotional materials. All other information provided in the nomination form will be treated as confidential.



Nominee’s Bio: Please limit the length to 300 words or less.

Company/Organization General Information

1. 
   What is the company’s/organization’s URL?
   

2. 
   Provide a brief description of the company or organization’s products or services.
   

3. 
   What is the total revenue of the company/organization?
   

Less than $500M

$500M-$1B

$1B-50B

$50-100B __ Greater than $100B

4. 
   What is the total number of employees in the company/organization?
   

Less than 10K

10K-50K

50K-100K __ Greater than 100K

5. 
   Please indicate the company’s/organization’s industry.
   

Agriculture and Mining

Business Services

Computers and Electronics

Consumer Services

Media and Entertainment

Non-profit

Other (please indicate: )

Real Estate and Construction




Education

Energy and Utilities __ Financial Services

Government

Retail

Software and Internet

Telecommunications

Transportation and Storage

Healthcare, Pharmaceuticals and Biotech Travel, Recreation and Leisure

Manufacturing

Wholesale and Distribution

6. 
   Does company/organization have a national or a global presence?
   

National __ Global

Company/Organization Information Security Department Information

1. 
   What is the total annual budget for Information Security?
   

Less than $1M

$1-25M

$25-50M XX More than $50M

2. 
   What percentage of the IT budget does this amount represent? 5%
   

3. 
   How many employees are in the Information Security Department? (Please indicate for both US and worldwide)
   

0-10

10-30

30-75 __ 150 or more

75-150

4. 
   Is the Information Security Department a part of the IT organization? Yes If not, please share which department.
   

All questions in this section are required to be answered for the nomination to be considered complete.

Please limit each essay question answer to 300 words or less.

1. Major Efforts & Accomplishments

An educator can help in many ways. Please select 3 of the following 4 educator categories most relevant to your efforts and follow the instructions for the corresponding questions on the next two pages. You may cite relevant supporting documents as applicable.

Note: The term “minority entrepreneurs” encompasses all stages of business ownership, including pre-startup.

1. 
   SUPPORTER | Raising awareness and advancing opportunities
   

Examples:

• 
  Advocacy of the creation of new opportunities or new resources benefiting minority cybersecurity students
  
• 
  Advocacy of policies, practices, legislation, etc. benefiting minority cybersecurity students
  
• 
  Community outreach to increase public awareness and support of minority cybersecurity students
  
• 
  Active participation in relevant organizations on behalf of minority cybersecurity students
  

2. 
   ADVISER | Providing education, training and/or mentorship
   

Examples:

• 
  Cybersecurity training and/or counseling provided to minority students (including “behind-the-scenes” involvement, such as hosting classes)
  
• 
  Mentorship of minority cybersecurity students
  
• 
  Specific technical assistance provided to minority cybersecurity students (e.g. financial advice, market research assistance, etc.)
  

3. 
   FACILITATOR | Developing connections to resources and opportunities
   

Examples:

• 
  Organization or growth of business-to-business networks (formal or informal) for minority cybersecurity students in order to help foster new business opportunities and relationships
  
• 
  Formation of strategic alliances with non-profit organizations, government agencies, other businesses, etc. to help minority cybersecurity students access new training resources or employment opportunities
  
• 
  Connecting minority cybersecurity students to existing business resources and/or employment opportunities
  

4. 
   INITIATOR | Creating programs and resources
   

Examples:

• 
  Creation of new resources benefiting minority cybersecurity students
  
• 
  Development of new programs for minority cybersecurity students
  

The examples given for the above categories are intended as a guide only. Your own efforts and services may or may not be similar.

SUPPORTER

Describe your efforts/actions raising awareness of the needs of minority cybersecurity students and/or advancing new policies, opportunities, etc. What are your specific accomplishments and what impact have those accomplishments had on the minority cybersecurity business community?

ADVISER

Describe your efforts to educate, advise, assist, mentor, etc. minority cybersecurity students. What is the approximate total number of minority cybersecurity students educated/assisted/mentored, and what are some significant results (such as certificates or degrees achieved, skillset improved, etc.)?

FACILITATOR

Describe your efforts to develop/grow networks, form strategic alliances and/or otherwise connect minority cybersecurity students to existing resources or employment opportunities. What are your specific accomplishments and how have these accomplishments benefited minority cybersecurity students?

INITIATOR

Describe any programs, resources, etc. benefiting minority cybersecurity students that you have developed or helped to develop. How specifically have minority cybersecurity students benefited? If applicable, approximately how many minority cybersecurity students have been assisted?

2. Other Qualifications

Describe additional efforts, accomplishments, characteristics, etc. not covered in the sections above that you feel merit this award.

3. Volunteer Efforts

Describe all of your volunteer efforts (i.e. efforts outside of your job) on behalf of minority cybersecurity students and/or the ICMCP community. (These can overlap with your other responses.)

Nominee Personal Interests

During the ICMCP® Awards Gala, the audience enjoys hearing about the personal side of our nominees as they are called to the stage. Please tell us about one or two of the following:

1. 
   Your hobbies: bike riding and traveling
   
2. 
   Community involvement: Volunteer at the Humane Society
   
3. 
   A secret ambition: To be a Stormchaser
   
4. 
   What you’d do if you won the lottery with a BIG payout: Set up a foundation to save distressed animals and the environment
   
5. 
   If you could meet anyone dead or alive, who would it be and why: George Washington – I’d love to learn from a true leader
   
6. 
   If you could be a famous person, who would you be and why:
   
7. 
   Your favorite movie and why: Two Days in the Valley – the twists are outrageous
   
8. 
   Your mentor
   
9. 
   Something not many people know about you: I can write backwards
   
10. 
    Anything else you’d like to share
    

Please do not include anything you would not want the audience to hear at the Awards Ceremony.

NOMINEE / NOMINATOR DECLARATION AND DETAILS

By submitting this form, I believe that the information I have provided is correct to the best of my knowledge. I authorize the release and use of any and all materials furnished in the nomination form for the purposes of evaluation and judging.

I understand that the nominee bio and photo submitted on this nomination form will be displayed on the ICMCP® website and may be used in publicity related to the ICMCP® Awards; and that all other information will be treated as confidential.

(Electronic submission of the form is taken to mean that the terms and conditions of this nomination form are accepted.) Nominee Authorization: (type name) Nominator Authorization: (type name if applicable) Date:

SUBMISSION QUICK CHECK LIST

1. 
   Did you complete the contact information where applicable in this document?
   
2. 
   Is the name, title and company/organization name of the nominee as you would like to see it printed in materials and on the website?
   
3. 
   Did you include the nominee’s bio in this document?
   
4. 
   Did you complete the nomination questions section?
   
5. 
   Did you complete a nominee’s personal Interest section?
   
6. 
   Did you fill in the nominee authorization, nominator authorization (if applicable) and date?
   
7. 
   Did you send a high-resolution photo of the executive to [e-mail]
   

NEXT STEPS

1. 
   Upon submission, an ICMCP team member will confirm receipt of completed nomination form and photo.
   
2. 
   An email will follow with details of the agenda of the ICMCP® Annual Conference and Awards and how to register for the program. Nominees, their teams, and qualified educators they would like to invite are eligible to attend the entire ICMCP® Annual Conference and Awards. (A qualified educator cannot work for a vendor that provides information security products or services.)
   
3. 
   Details will also be provided on hotel registration, rates and how to book your room.
   

For all questions, please contact:

Kate Shackford

Director, Development & ICMCP® Nominations

International Consortium of Minority Cybersecurity Professionals

31 Ellis Drive | North Haledon, NJ 07508

P: 917.913.0016

[e-mail]

Websites: www.icmcp.org

Thank you for participating in the ICMCP® North America Awards. Good luck to you!

International Consoritum of Minority Cybersecurity Professionals Logos are Registered Trademarks.


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