EQUALS in Tech Awards 2018 Nomination Form

Information of the Nominator
In this section, please input your information as the nominator. Please note, this section is BOTH for individuals nominating themselves and for those nominating others.

First name:

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* 1. First name:

Last name:

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* 2. Last name:

Email:

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* 3. Email:

Title:

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* 4. Title:

Name of Organization/Company

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* 5. Name of Organization/Company

Address:

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* 6. Address:

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Share with us an innovative initiative or project. Describe why you are nominating it and how their work has significantly advanced progress under the selected category.
Name of project/initiative

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* 7. Name of project/initiative

Website:

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* 8. Website:

Type of Stakeholder

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* 9. Type of Stakeholder

Category of Nomination:
Select one of the following options

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* 10. Category of Nomination:
Select one of the following options

Describe the work of the nominated work of the organization, including target audience, major objectives and activities (500 words max)

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* 11. Describe the work of the nominated work of the organization, including target audience, major objectives and activities (500 words max)

Describe the tangible results of the initiative/work and numbers of women/girls benefitted as a result of these activities (500 words max)

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* 12. Describe the tangible results of the initiative/work and numbers of women/girls benefitted as a result of these activities (500 words max)

Has this work been replicated and scaled?(250 words max)

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* 13. Has this work been replicated and scaled?(250 words max)

Please describe anything particularly innovative about this work? (250 words max)

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* 14. Please describe anything particularly innovative about this work? (250 words max)

Please list major partners in this initiative.

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* 15. Please list major partners in this initiative.

Please provide any relevant/related web links (photos, videos, websites, evaluations, testimonials, etc) for the above mentioned initiative/s. (500 words max)

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* 16. Please provide any relevant/related web links (photos, videos, websites, evaluations, testimonials, etc) for the above mentioned initiative/s. (500 words max)

Please list the name, address and contact number of 2 references

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* 17. Please list the name, address and contact number of 2 references

How did you hear about the EQUALS in Tech Awards?

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* 18. How did you hear about the EQUALS in Tech Awards?

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