Inspired Individuals | Nomination form

Nomination form

Please fill out the form below:
[Note: We are unable to accept nominations for people working in the UK, Western Europe, USA, Canada, Australia or New Zealand]

About you:

Your name:*


First Name		Last Name

Your email:*

Please tell us how you found out about the Inspired Individuals Initiative:

Which organisation or network do you represent:

What is your relationship with the person you are nominating?*

Do they know that you have nominated them?*

Yes No

Tell us about the person you are nominating:

Are they a committed Christian?*

Yes No

Name of the person you are nominating:*


First Name		Last Name

Their email address:*

Their phone number:

Their website (if they have one):

In which region is their work based?*

In which country/countries or sub-region is their work based? e.g. India or Bolivia, Peru, Colombia or Horn of Africa *

In which country / city do they live?* /

Tell us about the work they are doing

Have they started to implement their idea yet?*

Yes No

Is their work lifting people out of poverty or addressing social injustice?*

Yes No

What need / problem are they seeking to address?*

How are they doing that and how innovative is it?*

Having read about the type of support we can offer, in what way do you think Inspired Individuals can support this person?*