Nominate

Making a nomination is possible only by submitting a completed nomination form and the required supporting documents. Nominations must be submitted in English, Spanish, French or Dutch. Nominations can be easily submitted by filling in the on-line nomination form below. Take note: the on-line nomination form has to be completed in one sitting. Partially completed on-line forms cannot be saved to be completed at a later time. After the on-line form is completed it is, however, possible to download it.

Nominations can also be submitted by downloading a nomination form in Word, completing it, and then sending it by e-mail, post or fax. In this case, please remember to include the supporting documents. You will find the Word version of the form here.

There is also a PDF version of the nomination form available. You will find it here.

Online nomination form

Please note: you must complete the form in one attempt. It is not possible to stop and save a partially completed form.

Once you have completed the form, you can download a copy.

Information about nominee

Name:* Sex:* male female
Position:* Current address:* E-Mail:* Telephone:* The nominee knows that he/she is nominated*

Upload a photograph of the nominee here

Each application should include a photograph of the nominee. Upload here. Photo:

Biography of nominee

Mention here also previously won prizes.

Biography (maximum 300 words):*

Information about nominee's activities

Description of the human rights work of the nominee, focusing on the last year. This should include the goals and objectives of the work, the constituency and/or target group, the location of the activities, a description of the activities, and the results or impact of the work in terms of the promotion or protection of human rights.

Activities (maximum 300 words):*

Negative consequences and risks faced by the nominee

Description of the violations or negative consequences the nominee has faced or risks facing as a result of his/her work, how he/she has dealt with these and the effect on his/her work. Please explain how the nominee has shown exceptional moral courage in promoting and protecting the rights of fellow citizens.

Negative consequences and risks (maximum 300 words):*

Information about nominator

Name:* Sex:* male female Position:* Relation to the nominee:* Current address:* E-Mail:* Telephone:*

Information about references

At least two references are required.

First reference Name:* Position:* Relation to the nominee:* E-Mail:* Telephone:* Letter of recommendation:*

Second reference Name: Position: Relation to the nominee: E-Mail: Telephone: Letter of recommendation:

Additional supporting documentation

Additional supporting documentation (letters of recommendation, reports, articles, press clippings, videos, etc.) which can assist in the assessment of the nomination is welcome. There must be at least 1 document uploaded.

Supporting document 1: Supporting document 2: Supporting document 3:

Nominations must be received by 15 June 2010.

Submit nomination