SBA Form 3301 Small Business Person of the Year Nomination

OMB Control Number 3245-0360
Expiration Date:

National Small Business Week
SBA Form 3301, Small Business Person of the Year

Instructions; Refer to the National Small Business Week Award Nominations Guidelines
for detailed instructions for submitting nominations.
This form must be completed by the nominee or by the nominator. The completed form must be
submitted with the nomination package as noted in the award guidelines. Answer each question
as fully as possible; if it is not applicable, state N/A.

1. Lead Nominee Information:
a. Name:
b. Title:
c. Business name:
d. Business address:
e. Business phone number:
f. Business email address:
2. Co-nominee(s) Information (Note: you may nominate up to 3 additional co-nominees per
business. Each co-nominee must fill out the SBA Form 3300):
a. Name(s):
b. Title(s):
c. Email address(es):
3. Nominator Information (if you are nominating yourself, write n/a):
a. Nominator name:
b. Title:
SBA Form 3301 (08/2017) (Previous Editions Obsolete)

c. Address:
d. Phone number:
e. Email address:
4. Provide the nominee(s) percentage of ownership or stock owned in the small business.
5. How many years has the nominee’s business been operational (minimum 3 years)?
6. How many employees does the business currently have?
7. Does the business have a website? If yes, list the URL:
8. To assess the financial performance of the business for the last 3 calendar years, fill out the
chart below.
Financial Summary
Year

2014

2015

2016

Number of
Employees
Total Sales
Net Profit
(Before Tax)
Total Assets
Total Liabilities
Net Worth

Answer each of the following questions in 200 words or less.
9. Provide a biography for the nominee(s):
10. What type of SBA assistance has the business received (e.g. SBA loan, U.S. Export
Assistance Center, Veteran’s Business Outreach Center, Boots to Business, Procurement
Technical Assistance Center, government contracting, SCORE counseling, Small Business
Development Center (SBDC) assistance, Women’s Business Center (WBC) assistance,
disaster assistance, or Emerging Leaders Initiative)? Please explain (include the amount and
date of financial assistance received if applicable):
SBA Form 3301 (08/2017) (Previous Editions Obsolete)

11. Describe the nominee’s business, including areas served:
12. Has the business expanded to additional locations, grown in square footage or increased web
traffic since its founding? If yes, please explain.
13. Based on the financial chart provided above, please explain in more detail the business’s year
to year changes in financial health (e.g. sales, net profit, net worth) and number of
employees.
14. Does the business export? If yes, please explain.
15. Has the nominee had a financial, physical, legal, or other crisis while in business? Please
explain the situation and actions taken to resolve it.
16. Does the nominee contribute money, time or resources to his or her community or charitable
causes? If yes, please explain.
17. Is the nominee a member of a council, board or club providing support and services to his or
her community? If yes, please explain.

Caution: Penalties for False Statements
Knowingly making a false statement on this form is a violation of Federal law and could result in
criminal prosecution, significant civil penalties, and a denial of program participation or other
benefits awarded by the agency. A false statement is punishable under 18 U.S.C. §§ 1001 and
3571 by imprisonment of not more than five years and/or a fine of not more than $250, 000 and
under 15 U.S.C. § 645 by imprisonment of not more than two years and/or a fine of not more
than $5,000..
Paperwork Reduction Act Notice:
SBA will use the information collected on this form, along with other information submitted
by award nominees as part of the nomination package, to determine the nominee's eligibility
for a particular small business award; to identify any actual or apparent conflict of interest
and, to make eventual award determinations. Responding to this request for information is
voluntary. However, failure to provide the requested information may affect SBA’s ability
to make a decision regarding your eligibility for an award.
You are not required to respond to any collection of information unless it displays a currently
valid OMB control number (3245-0360). The estimated burden for completing this form is 1
hour and 15 minutes, including the time for reviewing the instructions, and gathering and
compiling data. Combined with the time for completing the Form 3300, the total estimated time
to prepare and submit the nomination package for each nominee is 90 minutes. Comments on
this burden estimate should be sent to the U.S. Small Business Administration, Chief, AIB 409
3rd St., SW, Washington, DC 20416, and Desk Officer for the U.S. Small Business
SBA Form 3301 (08/2017) (Previous Editions Obsolete)

Administration, Office of Management and Budget, New Executive Office Building, Room
10202, Washington, DC 20503. DO NOT SEND COMPLETED FORMS TO OMB. Submit
them to the location indicated in the nomination guide.

SBA Form 3301 (08/2017) (Previous Editions Obsolete)