Outstanding Achievement in Academia

Awarded to a female individual who has made an outstanding contribution to the field of academia.

ENTRANT`S DETAILS

Title:

First Name of Nominee:

Last Name of Nominee:

Job Title:

Company:

Email Address:

Company Address:

Telephone No

Mobile:

Date of Birth (DD-MM-YYYY):

Nationality:

Ethnic Origin:

IF YOU ARE NOT THE ENTRANT, PLEASE FILL IN YOUR DETAILS

Title:

Full Name:

Job Title:

Company:

Email Address:

Company Address:

Telephone No

Mobile:

THE QUESTIONS

1. Please outline why the nominated individual/organisation should be considered for the award? (200 words max) *

2) Provide relevant information on the nominee:Testimonials Achievements over the years, in most particular the past year (most recent first) Honours and awards (most recent first) (300 words max) *

3) List, all qualifications and institutions where the nominee studied: (most recent first) (200 words max) *

4) Provide a brief biography of the nominated individual/organisation (200 words max) *

5) Provide a summary of the nominee's approach to gender and ethnic diversity and its impact (250 words max) *

I confirm that I have read and understood the terms and conditions and agree to abide by them.