SBA Form 3312 Womens Business Outreach Center of the Year Award

OMB Control Number 3245-0360
Expiration Date: 11/30/2023

National Small Business Week

SBA Form 3312
Women’s Business Center 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. WBC Information:
a. Name:

b. Address:

c. Phone number:

d. Email address:

e. Website URL:
2. WBC Director Information:
a. Name:

b. Phone number:

c. Email address:
SBA Form 3312 (09/2021) (Previous Editions Obsolete)

3. Host organization information:
a. Organization name:

b. Executive director name:

4. Nominator Information (if applicable):
a. Nominator name:

b. Title:

c. Address:

d. Phone number:

e. Email address:
Answer each of the following questions in 200 words or less.
5. Provide a biography for the WBC director:

SBA Form 3312 (09/2021) (Previous Editions Obsolete)

6. Provide a description of the WBC’s services:

7. Provide a narrative of a WBC counselor who has excelled in providing counseling,
training and other program services to small businesses:

SBA Form 3312 (09/2021) (Previous Editions Obsolete)

8. Provide a narrative of a success story relating to a particular business served by the
WBC:

9. Provide a narrative of how the WBC has worked with the local SBA District Office as a
champion for SBA products and services including effective amplification of the SBA
mission and priorities and strong education efforts about the SBA and its programs to
small businesses:

SBA Form 3312 (09/2021) (Previous Editions Obsolete)

Answer the following question in 400 words or less.
10. Provide a business profile including the WBC mission statement, target market, and types
of services offered, including any specialized programs or services. The profile should
include performance on key milestones for the last three years.

SBA Form 3312 (09/2021) (Previous Editions Obsolete)

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
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 3312 (09/2021) (Previous Editions Obsolete)