Nominator |
| First Name:* | | | | Last Name:* | | |
| Title: | | |
| Position:* | | | | Organization:* | | |
| Street Address: | | | | PO Box: | | |
| Street (2): | | | | Mail Code: | | |
| Street (3): | | | | City:* | | |
| State: | | | | Country:* | | |
| Gender:* | | | | Date of Birth (yyyy/mm/dd): | | |
| Telephone: | | | | Fax: | | |
| E-mail:* | | | | Nationality: | | |
Young Global Leader Candidate |
| First Name:* | | | | Last Name:* | | |
| Title (Mr, Mrs, Dr, etc...): | | |
| Position:* | | | | Organization:* | | |
|
| Profile (Biography) (< or > signs are not authorized! - Max 200 words):* |
| | | |
| Organization profile (< or > signs are not authorized! - Max 100 words): |
| | | | Street Address: | | | | Street (2): | | |
| Street (3): | | | | PO Box: | | |
| Mail Code: | | | | City:* | | |
| State: | | | | Country:* | | |
| Gender:* | | | | Date of Birth (yyyy/mm/dd):* | | |
| Telephone: | | | | Fax: | | |
| E-mail:* | | | | Nationality:* | | |
Comments |
|
| What distinguishes this candidate as a leader who positively impacts the world? (< or > signs are not authorized! - Max 200 words)* |
| | | |
| Please describe the candidate's commitment to serve society at large (e.g. volunteerism, involvement in non-for-profit organizations, examples of thought leadership, public service, etc...) (< or > signs are not authorized! - Max 200 words)* |
| | | Add supporting documents (Total size of 10MB max) |
|
| Candidate's updated CV (.doc|.rtf|.txt|.zip)* |
| | | |
| Candidate's recent photo (.jpg|.jpeg|.gif|.zip) |
| | | |
| Any other supporting documents (.zip) |
| | |
Should you like to submit more than one document per field, please zip the documents beforehand.