Title and Full Name Current position/s and name of applicable institution/ employer Address Telephone number Cell number Website (if E-mail applicable) Seconder (The details required below are those of the person seconding the nomination) Title and Full Name Current position/s and name of applicable institution/ employer Address Telephone number Cell number Website (if E-mail applicable) Part 3: Not required Part 4: Communications Officer (The details required below are those of the person responsible for communications with the media at the NGO. Details only required where they are not the same as for the NGO) Title and Full Name Physical address Telephone number Cell number Website (if E-mail applicable) Part 5: Specific category in which this nomination is being made (Indicate, in the block on the right below the category in which you are nominating the candidate by number) 8. to SET by an NGO Award for a Non-Governmental Organisation –contribution including innovation, technology transfer and education and training activities over the last 5 to 10 years. Part 6: Nominations in other categories Indicate whether a nomination of any of the team members in another category is to be made. Yes/No If Yes, indicate the relevant category in the following table by number below.
Title and Full Name Current position/s and name of applicable institution/ employer Address Telephone number Cell number E-mail Website (if applicable) Seconder (The details required below are those of the person seconding the nomination) Title and Full Name Current position/s and name of applicable institution/ employer Address Telephone number Cell number E-mail Website (if applicable) Part 3: Not required Part 4: Communications Officer (The details required below are those of the person responsible for communications with the media at the NGO. Details only required where they are not the same as for the NGO) Title and Full Name Physical address Telephone number Cell number E-mail Website (if applicable) Part 5: Specific category in which this nomination is being made (Indicate, in the block on the right below the category in which you are nominating the candidate by number) 8. Award for a Non-Governmental Organisation –contribution to SET by an NGO including innovation, technology transfer and education and training activities over the last 5 to 10 years. Part 6: Nominations in other categories Indicate whether a nomination of any of the team members in another category is to be made. Yes/No If Yes, indicate the relevant category in the following table by number below.
18NominationFormNGO.docx