Please indicate the award category for which this nomination is to be considered.
This field is required
Please provide a statement of support (no more
than two pages) demonstrating the nominee’s
achievements, referring to the selection criteria
for the relevant category. Awards will be judged
through consideration of the selection criteria.
Supporting evidence can include photographs or
publications demonstrating an activity or event.
Please provide the details of two people who are familiar with the work of the nominee and who agree to support this nomination.
Declaration by nominator: