1 Nominee’s Details 2 Education & Profession 3 Category, SDGs & Impact 4 Evidence & References Full Name (as in official documents) Nominee’s Date of Birth Nominee’s Age Nationality --Select--AfghanAlbanianAlgerianAndorranAngolanAntiguan and BarbudanArgentineArmenianAustralianAustrianAzerbaijaniBahamianBahrainiBangladeshiBarbadianBelarusianBelgianBelizeanBenineseBhutaneseBolivianBosnian and HerzegovinianBotswananBrazilianBruneianBulgarianBurkinabeBurundianCape VerdeanCambodianCameroonianCanadianCentral AfricanChadianChileanChineseColombianComorianCongolese (Democratic Republic)Congolese (Republic)Costa RicanCroatianCubanCypriotCzechDanishDjiboutianDominicanDominican RepublicEast Timorese (Timorese)EcuadorianEgyptianSalvadoranEquatorial GuineanEritreanEstonianEswatiniEthiopianFijianFinnishFrenchGaboneseGambianGeorgianGermanGhanaianGreekGrenadianGuatemalanGuineanGuinean-BissauanGuyaneseHaitianHonduranHungarianIcelanderIndianIndonesianIranianIraqiIrishIsraeliItalianIvorianJamaicanJapaneseJordanianKazakhstaniKenyanI-KiribatiKosovarKuwaitiKyrgyzstaniLaotianLatvianLebaneseLesothanLiberianLibyanLiechtensteinianLithuanianLuxembourgerMalagasyMalawianMalaysianMaldivianMalianMalteseMarshalleseMauritanianMauritianMexicanMicronesianMoldovanMonegasqueMongolianMontenegrinMoroccanMozambicanMyanmareseNamibianNauruanNepaleseDutch (Netherlands)New ZealanderNicaraguanNigerienNigerianNorth KoreanNorth MacedonianNorwegianOmaniPakistaniPalauanPanamanianPapua New GuineanParaguayanPeruvianFilipinoPolishPortugueseQatariRomanianRussianRwandanKittitian and NevisianSaint LucianSaint Vincent and GrenadinianSamoanSammarineseSão Tomean and PrincipeanSaudi ArabianSenegaleseSerbianSeychelloisSierra LeoneanSingaporeanSlovakSlovenianSolomon IslanderSomaliSouth AfricanSouth KoreanSouth SudaneseSpanishSri LankanSudaneseSurinameseSwedishSwissSyrianTaiwaneseTajikTanzanianThaiTogoleseTonganTrinidadian and TobagonianTunisianTurkishTurkmenistaniTuvaluanUgandanUkrainianEmirati (UAE)British (UK)AmericanUruguayanUzbekVanuatuanVatican CityVenezuelanVietnameseYemeniZambianZimbabwean Country --Select--Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo (Democratic Republic) Congo (Republic) Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea North Macedonia Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Contact Number (with country code) Nominee’s Email LinkedIn Profile URL Next Highest Academic Qualification Field of Study Institution Year of Graduation Professional Background Current Occupation / Job Title Organization / Institution Year of Commencement Previous Relevant Roles (If Any) Previous Next Award Category Please select the category that best describes your work (choose one) Leadership & Governance Corporate & Professional Sectors Innovation & Technology Social Impact Arts, Culture & Sports Entrepreneurship & Business Sustainable Development Goals (SDGs) Which Sustainable Development Goals (SDGs) does your work align with? (select all that apply) No Poverty (SDG 1) Zero Hunger (SDG 2) Good Health & Well-being (SDG 3) Quality Education (SDG 4) Gender Equality (SDG 5) Decent Work & Economic Growth (SDG 8) Industry, Innovation & Infrastructure (SDG 9) Reduced Inequalities (SDG 10) Climate Action (SDG 13) Peace, Justice & Strong Institutions (SDG 16) Partnerships for the Goals (SDG 17) Other Other Sustainable Development Goals (SDGs) does your work align with? (select all that apply) Previous Next Refrence Please provide details of at least one referee (professional or academic) who can validate your work and impact: Name Relationship Contact Submit The form was sent successfully. An error occured. Previous The form was sent successfully. An error occured.