ENGAGe Award Nomination Form

ENGAGe Award Nomination Form
Name*

First NameLast Name
Association*
Country*
Email*
example@example.com
Are you nominating yourself or someone else?*

SelfAnother project/organisation

Advocacy Project Overview
Project title*
Start date*

MonthDayYear
Date
End date*

MonthDayYear
Date
Geographical Scope*

LocalNationalCross-border
Provide a short summary of the project below*

Main narrative
What issue did your project address and why was it important?*

0/200
What was the impact? (include data or quotes if available)*

0/200
How did you communicate with your audience(s)? (languages, channels, innovations)*

0/200
What are your next steps to sustain or scale this work?*

0/200

Supporting materials
Upload your 90-second video introduction (not compulsory)

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Or insert a link here
1 page visual summary / 4 page PPT (including infographic, diagram, campaign image)*

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Letter of support (quote from a participant, medical advocate letter etc.)

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Should be Empty: