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ICANN Multistakeholder Ethos Award 2019: Nomination Form
Nomination Form Instructions:
Please fill in all required fields to submit a nomination for the 2019 Multistakeholder Ethos Award Process. If you wish to nominate multiple ICANN community members, please fill in a form for each nominee. Nominations should include all necessary information against the award criteria for the community panel to understand why the nominee should be selected as this year's recipient.

Please submit any further documentation in support of your nomination or any questions about the nomination process to ethosaward2019@icann.org.

Nominations close on 22 March 2019.

Privacy:
Please note that any personal data collected and stored via the submission of this form is subject to ICANN’s Privacy Policy and in addition will not be published or shared with anyone outside the community evaluation panel.
Award Overview:
Nominator Information:
Your Name (Nominator): *
Your answer
Your Email Address: *
Your answer
Community of Nominator/Person Completing Form: *
If "Other", Please Specify:
Your answer
Nominee Information:
Name of Nominee: *
Your answer
Community of Nominee: *
If "Other" Please Specify:
Your answer
Please Review the 2019 Multistakeholder Ethos Award Criteria:
Please explain how the nominee meets the award criteria # 1: *
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Your answer
Please explain how the nominee meets the award criteria # 2: *
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Your answer
Please explain how the nominee meets the award criteria # 3: *
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Your answer
Please provide any further information in support of your nomination for panelists to review during the deliberation process as appropriate:
Your answer
If called upon, would you be willing to discuss your nomination with panelists during the selection process via a conference call? *
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