Step 1/3
Nominee & Nominator Information

Nominee Information

Full Name:
Age: (as of Feb 28th, 2010)
Phone Number:
Email:
* This address will receive a confirmation for this application
Address:
Organization:
(if applicable)
Is this a self-started initiative?
Parent/Guardian's Name:
Parent/Guardian's Phone Number:
Parent/Guardian's Email:
How did you find out about this?

Nominator Information

(If you are nominating yourself, please leave the section below
blank and click "Next" to move on to Step. 2)

Full Name:
Phone Number:
Email:
Relation to Nominee:
Time You Have Known Nominee:

Step 2/3
Specify Award to Apply

Please indicate the category which
you are applying for:

Youth Acting Globally Award
Youth Acting Locally Award
Please describe your project in the space provided:

Step 3/3
Description & Explaination

What makes you (or nominee)
an Agent for Change?

In 500 words or less describe yourself (or the nominee) and explain how you/they have made the world a better place.

Along with your description, he following points should be addressed:

  1. What inspired you (nominee) to explore your particular issue?
  2. What kind of social change came about as a result?
  3. What challenges were faced and how were they overcome?
  4. What kind of future initiatives would you (nominee) like to implement, if any? We are particulariy seeking youth and projects with long term objectives, rather than one time initiatives.

Type your description & explanation below: