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ICIMOD Mountain Prize

Nomination form – ICIMOD Mountain Prize 2020











Individual nomination formOrganizational/Company nomination form

1. Nominator’s (i.e., your) information

Your full name







City and country in which you live



Your contact details (landline/phone number, mobile/cell number, email address, fax number)






2. Individual nominee information

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)



2. Organizational/company nominee information



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)




3. Nomination form

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)*

YesNoNot applicable

I confirm that the above information is accurate and complete to the best of my knowledge.