NASMA | Nomination Form

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Nomination Form

Please complete the form below to submit your nomination.

Nominator Information

Full Name of Nominator Email Address Phone Number Organization / Affiliation (if any)

Nominee Information

Full Name of Nominee Gender Email Address (optional) Phone Number (optional)

NASMA Eligibility Qualification

Primary Eligibility Pathway (Select ONE)

Award Category

Select Award Category

Impact & Achievement Details

Achievement Location Brief Summary of Nominee’s Contribution (Max 250 words)

Supporting Evidence (Optional)

Type of Supporting Evidence

Period of Impact (Years)

Declaration & Integrity

I affirm that the nominee has not lobbied, induced, or influenced this nomination. I confirm that all information and documents submitted are accurate and verifiable.