Nomination Form

! Please read first Rules & Regulations!

Deadline 1st of September2018

1. Nominator’s details
First Name
Last Name
Female/Male
Nationality
Organisation
Job title
Work address
Country
Telephone
Email
Website of Organisation
A brief description of nominator’s organisation (approximately 100 words)
Nominator’s contact person and/or relationship with Both ENDS[1].If there has been no contact with Both ENDS how did you come to know about the JWH?
2. Candidate’s personal details
First Name
Last Name
Female/Male
Telephone
Date of birth
Nationality
Language skills
Relationship with nominator
3. Candidate’s work details
Organisation for which the candidate is presently working
Postal address
Country
Telephone
Email
Website of Organisation
A brief description of candidate’s organisation (approximately 100 words)
Job title of candidate
Description of candidate’s job responsibilities
If applicableCandidate’s contact person with Both ENDS[2]
4. Candidate’s leadership capacities
Description of the candidate’s leadership potential based on dedication at work, commitment and outstanding achievements. Such as being able to motivate others, showing ambition to learn and to lead etc (approximately 100 words)
Describe the candidate’s major achievements which demonstrate her/his lasting commitment to working for a sustainable environment and environmental justice. (approximately 200 words)
5. Goal - Please describe the goal of the candidate’s leadership development for this grant. Why is the candidate applying for this grant and what does the candidate hope to achieve with the grant? (min. 100 and max. 300 words)
6. Skills & Objectives – Please fill in the skills/knowledge which the candidate wants to improve and which objective the candidate thus wants to reach.
The candidate wishes to improve the following skill/knowledge / With the skill/knowledge the candidate wishes to reach the following objective

(Add more lines if necessary)

7. Activities – Please fill in the activities (for example, name of training, course, education, internship etc) which the candidate wants to carry out. The activities mentioned should correspond to the skills mentioned above.
Activity 1
Type of activity
Name of involved institution(s) and any online information available (for ex. link to courses)
Place (city & country)
Description of activity, (for ex. content and hours of a course/training/internship)
Start – End
Estimated cost
Activity 2
Type of activity
Name of involved institution(s)
Place
Description of activity
Start – End
Estimated cost

(Add more boxes for further activities if necessary)

Grant & Budget- Please specify as much as possible what the grant would be spent on.
Budget / Activity / Specification(what will the money be spent on, for ex. fees, tickets, accommodation etc, please specify per item) / Total Cost per activity
1
2
Total
Grant
Indicate (with an X) for which category the candidate is being nominated. / € 2.500
€ 5.000
€ 7.000
6. References - Two individuals(other than the nominator!) are required who can personally vouch for the candidate, who are traceable and verifiable through the internet and can be contacted to validate the candidate’s leadership potentials. Please note that if we can not verify their existence or are receive no response to our inquiries this can seriously impact the eligibility of your nomination. All fields need to be filed to make them eligible.
Personal reference I
Name
Function
Organisation + Website
Telephone Number
Email
Relationship with candidate
Personal reference II
Name
Function
Organisation + Website
Telephone Number
Email
Relationship with candidate

Attached:

  • Candidate’s CV
  • Candidate’s Digital Picture

1

[1] If the nominator has previously had contact with somebody from Both ENDS please indicate here with whom and relate the form of this connection.

[2] If the candidate has previously had contact with somebody from Both ENDS please indicate here with whom and relate the form of this connection.