Nominating Myself*

Yes

Your name (if nominating someone else):*

Last Name*

Your email address (if nominating someone else):*

Confirm Email Address*

Tell us what you do, including your job title (if nominating someone else):

Your relationship to your nominee (if nominating someone else):

First Name

Last Name

Nominee’s gender:*

Nominee’s primary country of residence*

Nominee’s job title*

Nominee’s organisation: *

Nominee's Email Address

Category of nominee’s area of impact (select all that apply): *

Other*

1. No Poverty

2. Zero Hunger

3. Good Health and Well-Being

4. Quality Education

5. Gender Equality

6. Clean Water and Sanitation

7. Affordable and Clean Energy

8. Decent Work and Economic Growth

9. Industry, Innovation and Infrastructure

10. Reduced Inequalities

11. Sustainable Cities and Communities

12. Responsible Consumption and Production

13. Climate Action

14. Life Below Water

15. Life on Land

16. Peace, Justice and Strong Institutions

17. Partnerships for the Goals

Online Profile Link (LinkedIn, personal website, blog, etc): *

Personal Statement (max 400 words) or description of nominee’s work and impact (max 600 words): *

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