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* 1. Award Category

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* 2. Contact Information

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* 3. Current Position Title

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* 4. How do you prefer to be contacted

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* 5. 100-word statement about the organisation by which you are employed

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* 6. 100-word statement about yourself

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* 7. 250-word statement on the criteria of 'Achievement'

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* 8. 250-word statement on the criteria of 'Impact'

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* 9. 250-word statement on the criteria of 'Leadership'

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* 10. 250-word statement on the criteria of 'Commitment'

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* 11. 250-word statement on the criteria of 'Innovation'

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* 12. 250-word statement on the criteria of 'Personal Credibility'

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* 13. 250-word statement on the criteria of 'Strategic Contribution

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* 14. Please upload your supporting evidence for the submission statements above (up to 15 single sided pages total).

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen

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* 15. Additional uploaded supporting evidence for the submission statements above if required (up to 15 single-sided pages total)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen

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* 16. Referee One

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* 17. Referee One Current Position Title

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* 18. Referee One Relationship to you

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* 19. Referee Two

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* 20. Referee Two Current Position Title

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* 21. Referee Two Relationship to you

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* 22. Referee Three

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* 23. Referee Three Current Position Title

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* 24. Referee Three Relationship to you

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* 25. Please add any further explanatory comments regarding your submission below [max 200 words]

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* 26. Please supply a 100 word statement which will be used in the Awards evening programme, should you reach the finalist stage

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