UNFPA Bosnia and Herzegovina Award

AWARD NOMINATION SHEET

Entries must relate to contributions (e.g. published article, implemented activity, setting of good practices etc.) carried out in Bosnia and Herzegovina between 15 November 2016 and 1 November 2017. Submissions must be sent in electronic form to email – bosnia-herzegovina.office@unfpa.org by 17 November 2017.

Each nominator is asked to submit no more than one nomination, either for an individual or for an institution. Only nominations which provide the information requested on this Award Nomination Sheet will be considered valid. Please note that the information required should be provided on this sheet and if more space is needed, please attach additional pages. Self-nominations are accepted.

Nominations have to include supporting materials outlining specific examples of the nominee’s efforts and achievements. Submissions without relevant supporting documents will not be considered.

I. Nominator Information

A. Written nominations for the United Nations Population Award may be received from the following categories of nominators

B. Please provide additional information below for the category you indicated above.

Nominator’s Name

If not individual nominator, then name of government, organisation or business

Address

Telephone No.

E-mail

II. Nominee Information

Please tick relevant category for your nominee

Please tick relevant key priority area of your nominee

Please provide additional information for the nominee

Nominee’s Name

If not individual nominee, then name of government, organisation or business

Address

Telephone No.

E-mail

III. Contribution of Nominee to Selected Key Priority Area

Please describe the contribution of the nominee for the advancement of the selected priority area (max 1,500 characters):

IV. Declaration of Nominator

I confirm, that I have read and understand the requirements which relate to this nomination. I confirm that all information in this form are accurate.

Name

Address

Telephone No.

Email

Date Click here to enter a date.

Signature of Nominator