Henley & Partners Global Citizen Award^® Nomination Form

Please provide a short profile of the nominee (max 300 words max)*

Please select the global issue that the nominee's work is focused on. Should you need further information on global issues, please see https://www.un.org/en/global-issues/*

Briefly describe the nominee's professional background (150 words max)*:

Describe the nominee's work at local level and how this has impacted the lives of vulnerable communities (300 words max)*:

Please describe how the nominee's work has impacted or will impact the targeted global issues (300 words max)*:

Please add any additional information in support of your nomination (300 words max)*:

List any publications, articles, videos, and/or blogs about the nominee that support your nomination (maximum five)*:

Please list any other awards or accolades that the nominee already received*:

Please attach an image of nominee:

References - only where the nominee is recommended for work done in their individual capacity and not as a representative of an organization. Please provide updated contact details of two persons who are familiar with the work of the nominee but who are not related to them. Please note that the referees will be contacted: