Global reputation Nomination form - Reputation Poll Intl

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Global Reputation

Nomination Form

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SECTION 1: NOMINEE INFORMATION

Full Name of Nominee: *

First

Last

Nationality / Country of Origin *

Current Residence (City, Country) *

Profession / Primary Field of Impact *

Organization / Institution / Affiliation (if any)

Position / Role

Profession / Primary Field of Impact Options

Leadership & Governance
Business & Entrepreneurship
Arts, Media & Culture
Science & Innovation
Social Impact & Philanthropy
Education & Advocacy
Sports

Other (Specify)

Active Social Media Profiles

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

SECTION 2: NOMINATION DETAILS

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: *

Values Options *

Integrity
Transparency
Impact
Leadership
Innovation
Service
Resilience
Inclusivity

SECTION 3: NOMINATOR INFORMATION

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)

SECTION 4: VERIFICATION

*

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.

Global Reputation

Nomination Form

Please enable JavaScript in your browser to complete this form.

Please enable JavaScript in your browser to complete this form.

SECTION 1: NOMINEE INFORMATION

Full Name of Nominee: *

First

Last

Nationality / Country of Origin *

Current Residence (City, Country) *

Profession / Primary Field of Impact *

Organization / Institution / Affiliation (if any)

Position / Role

Profession / Primary Field of Impact Options

Leadership & Governance
Business & Entrepreneurship
Arts, Media & Culture
Science & Innovation
Social Impact & Philanthropy
Education & Advocacy
Sports

Other (Specify)

Active Social Media Profiles

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

SECTION 2: NOMINATION DETAILS

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: *

Values Options *

Integrity
Transparency
Impact
Leadership
Innovation
Service
Resilience
Inclusivity

SECTION 3: NOMINATOR INFORMATION

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)

SECTION 4: VERIFICATION

*

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.

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