Americas_50_Under_50_Nomination_Form

CULTURAL KARE MAGAZINE: AMERICA’S 50 UNDER 50 NOMINATION FORM
America's 50 Under 50 Nomination Form

Celebrating Changemakers & Trailblazers Across America! Complete the form below to nominate an individual for Cultural Kare Magazine's 'America's 50 Under 50' list. Nominations close on

December 31, 2024, at 11:59 PM EST.
SECTION 1: NOMINEE INFORMATION
1 Full Name of Nominee
2 Age Must be 49 or younger in 2024
3 Email Address
example@example.com
4. Phone Number

Area CodePhone Number
Cultural Identity
Black, Indigenous, Person of Color (Asian, Latinx, Middle Eastern, etc.)
6 Residence City State
SECTION 2: NOMINATION DETAILS
Field or Area of Impact (Check one):
Other please specify
What Makes This Nominee a Changemaker or Trailblazer?
Explain how this individual has made a cultural impact within the past year.
Key Accomplishments in 2024
List any milestones, projects, or notable achievements the nominee has accomplished this year.
Press, Awards, or Supporting Links

Browse Files
Share any articles, awards, or relevant links showcasing the nominee’s contributions. Cancelof
SECTION 3: NOMINATOR INFORMATION
11 Your Full Name
12 Your Email Address
example@example.com
13 Your Relationship to Nominee Self Colleague Friend etc
How Did You Hear About This Campaign?
Other please specify
SECTION 4: TERMS & CONDITIONS
Acknowledgment

- I confirm that all information submitted is accurate to the best of my knowledge.

- I understand that submitting this nomination does not guarantee selection.
Signature
Should be Empty:

CULTURAL KARE MAGAZINE: AMERICA’S 50 UNDER 50 NOMINATION FORM

SECTION 1: NOMINEE INFORMATION

SECTION 2: NOMINATION DETAILS

SECTION 3: NOMINATOR INFORMATION

SECTION 4: TERMS & CONDITIONS