VETTING
Nomination
Form
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Nomination Form
01 Source ID (Nominator)
Title
Select Title
Mr
Mrs
Ms
Dr
Prof
Required.
Full Name
Name required (letters only).
Mobile Number
Valid phone required.
Email Address
Valid email required.
02 Target Profile (Nominee)
Title
Select Title
Mr
Mrs
Ms
Dr
Prof
Required.
Full Name
Name required (letters only).
Mobile Number
Valid phone required.
Email Address
Valid email required.
Designation / Role
Designation required.
Origin Country
Select Origin...
Uganda
Kenya
Tanzania
Nigeria
South Africa
Other African Nation
Country required.
Organization
03 Classification Matrix
Award Category
Select Category...
Business & Entrepreneurship
Governance & Public Service
Social Impact & Community
Technology & Innovation
Youth & Women Empowerment
Pan-African Leadership
Category required.
Specific Award
Select Category First...
Specific award required.
04 Merit Statement
Impact Analysis (Min 100 chars / Max 1000)
Detailed justification (100-1000 characters) required.
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