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Your full name
City and country in which you live
Your contact details (landline/phone number, mobile/cell number, email address, fax number)
Your nominee’s full name
City and country in which your nominee currently resides/works
Your nominee’s contact details (phone number and email address)
Full name of the Head of the organization or company (please include his/her proper job title)
City and country in which the nominated organization or company is based
Contact details of the nominated organization or company (landline/phone number, email address, fax number)
SECTION A. Thematic areas of work
SECTION B. Setting the context
Provide an overview of your nominee’s outstanding work. What were the expected results of the work, and where in the Hindu Kush Himalayan region was it carried out? (e.g., was it an individual effort, or did the nominee work as a part of a larger team? If it was a team effort, who were the key partners?) [300 words]*
SECTION C. Sustainable mountain development and resilience building
How did the nominee’s work contribute to sustainable mountain development or enhance the resilience of the target community or mountain ecosystem (e.g., did it improve the health of a forest, wetland, springshed/watershed, rangeland; did it improve socio-economic conditions, access to goods or information, etc.)? [400 words]*
SECTION D. Transformative change
How has the nominee’s work contributed to transformative change on the ground in terms of social, economic and environmental factors (e.g., how many households or people benefitted from the work – directly and indirectly– and how; did it lead it to greater gender and social equity in the target community, and how)? [400 words]*
SECTION E. Gender and social inclusivity
How does the nominee’s work address gender or other social inclusion issues? [400 words]*
SECTION F. Prize worthiness
Why does your nominee deserve to win the ICIMOD Mountain Prize? [100 words]*
SECTION G. Supporting documentation
Compile into one document and upload here electronic copies of any supporting documents that provide evidence of your nominee’s outstanding work and achievements.
Does the head of your nominated organization/company know that you have nominated his or her organization/company for the ICIMOD Mountain Prize? Yes or No? (If you chose “No”, please inform him/her accordingly)*