2017 Michiana Forty under 40 Nomination Form








Michiana Forty under 40 shines the spotlight on 40 of the area's most talented and dedicated young executives, professionals and leaders who demonstrate career success and community engagement.

The 2017 class will represent the 11th Michiana Forty under 40 class with 400 leaders already receiving recognition. This program is an annual collaborative effort between the South Bend Regional Chamber, the Young Professionals Network South Bend and other partners in the Michiana region.



Nominate individuals within the Michiana region who demonstrate the following:

\\ Initiative and dedication in pursuing their career

\\ Proven success and achievement in their job/career

\\ Investment in and service to others through their involvement in civic, charitable and/or religious organizations

\\ Passion for their community, giving back because of that passion

\\ Under the age of 40 on May 16, 2017

\\ Live and work in Michiana (LaPorte, St. Joseph, Elkhart, Starke & Marshall counties in Indiana; and Cass & Berrien counties in Michigan)

\\ Nominees may be eligible in these and other industry sectors: education, health care, business/professional, social services/not-for-profit, government/public service, financial services, attorneys

NOTE: Please make sure to check Previous Recipients below to see if your nominee has already been recognized in the past. Persons can only receive the honor once.

To be considered for the recognition, an individual needs to be nominated first. To nominate an individual, please complete the form below. Only online nomination forms will be considered by the selection committee. Do not provide supplemental information. It will not be considered. Once you've completed the form, please remember to hit the "Submit" button. Upon form submission, you will receive a thank-you confirmation.

Helpful Tip to the Nominator: When completing the form, make sure to "sell" the nominee. Why should this individual be considered? Expand on the nominee's business and community accomplishments. Don't simply list them.   



If you have any questions, contact Paul Laskowski at 574.400.4004 or email him at plaskowski@sbrchamber.com. Only online nomination forms will be considered by the selection committee. Do not provide supplemental information.



Nominations will be accepted through Friday, March 10, 2017. Individuals selected will be recognized at a luncheon Tuesday, May 16 at the Gillespie Conference Center in South Bend. In addition, there will be a Michiana Forty under 40 Alumni Reception, including the 2017 class, on Monday, May 15. More details on the luncheon and reception to come.  


Previous Recipients

Names of Past Recipients (alpha order by last name)



*Nominator's Name
*Nominator's Company/Organization
*Nominator's Address (work or home)
*Nominator's City, State, ZIP
*Nominator's Phone Number
*Nominator's Email
*Name of Individual You Are Nominating
*Nominee's City of Residence
*Nominee's Phone Number (work or home)
*Nominee's Email (work or home)
*Nominee's Date of Birth (must be under the age of 40 on May 16, 2017)
*Nominee's Current Job Title/Position
*Nominee's Current Employer
*Nominee's Employer Address
*Nominee's Employer City, State, ZIP
*List any colleges attended, degrees earned by the nominee
*List/describe the nominee's business accomplishments (job responsibilities, results, special projects, business-related affiliations)
*List/describe the nominee's community involvement (civic, charitable and/or religious involvement)
*Nominee's special achievements, awards & special recognition
Nominee's family (spouse, children, if applicable)
Additional Comments


Platinum Trustees

1st Source Bank
AM General
Beacon Medical Group
Faegre Baker Daniels
Crowe Horwath LLP
Four Winds Casino Resort
Key Bank
Saint Joseph Regional Medical Center
South Bend Tribune
Teachers Credit Union
University of Notre Dame
Wells Fargo