Global reputation Nomination form - Reputation Poll Intl

Global Reputation

Full Name of Nominee: *

First

Last

Nationality / Country of Origin *

Current Residence (City, Country) *

Profession / Primary Field of Impact *

Organization / Institution / Affiliation (if any)

Other (Specify)

Active Social Media Profiles

Link to the nominee’s official website or active social media profiles

Why are you Nominating this Person? *

How has the nominee contributed to Africa’s reputation globally? *

What values best describe this nominee? *

Notable Achievements / Recognitions: *

Your Full Name *

Email Address *

Country *

Relationship to Nominee *

Why do you believe this nominee deserves to be listed among the 100 Most Reputable Africans? *

Other (specify)

I confirm that all information provided is accurate to the best of my knowledge.
I understand that submission of this form does not guarantee selection.
I consent to Reputation Poll International contacting me for further information if required.