Nomination Form

Nominee's Name

First Last

Nominee's Email

What's your nominee's job title and organization, if applicable?

Where are they based (city/region + country)?

How are you connected with this leader? How long have you known them and in what capacity? (no more than 150 words)

Why is your nominee a great fit for the Reimagine Award? What systems change impact have they had, or are they poised to have in the future? (no more than 300 words)

Does your nominee have a website or web presence (e.g. social media handles) where we can find out more about your nominee?

Your Name

First Last

Your Email