YOUTH CIVIC ENGAGEMENT AWARD

(CfN) # CEP-YCEA-02

NOMINATION FORM

YCEA will honor successful young men and women (aged 18 - 29), informal youth groups(consisting of at least three members), and youth CSOs that have demonstrated exemplarycommitment to improving the life of their community or that of the society at large by undertaking actions that address issues of public concern at any level in Macedonia. YCEA will be awarded for actions that the nominees have undertaken duringJanuary - December 2017.

To nominate candidates for YCEA, pleasecomplete the YCEA Nomination Form attached and follow the instructions in each section. It is important that you provide as much information as possible about your nominee, and explain their actual contribution and impact. Please, send in examples of the Nominee's work (e.g., videos, photographs, books, articles, etc.). These supporting materials should not exceed 5 (five) pages. All nomination materials will remain property of CEP and will not be returned.

Confidentiality agreement

The information contained in this nomination form is strictly confidential and will not be communicated to any person other than those involved in the administration of YCEA, with the exception of the background information which may be used in association with the announcement of the recipient and/or promotion of the award.

The deadline to submit your nomination and supporting documents is 12:00, April 5, 2018.

Please, submit the nomination package via e-mail at: th subject line “CEP-YCEA-02” or in hard copy in a sealed envelope addressed to: National Youth Council of Macedonia, Aminta Treti br. 29/1-3,1000 Skopje, att: Mr. Martin Miloshevski.Please direct all questions to: Martin Miloshevski at

To nominate an individual, informal youth group or youth CSO, please complete the following form in English:

  1. Nominee Category (please mark with X)

Individual
Informal Group
Youth CSO
  1. Nominee information

Please fill out the data only for the selected category that you nominate (Individual, Informal Group or youth CSO)

INDIVIDUAL CATEGORY
Nominee Name:
Date of birth:
City: Region:
Landline phone number: Cell phone:
Individual Nominee’s Email:
INFORMAL YOUTH GROUP CATEGORY
Name of group (if applicable):
Group members and dates of birth (list at least three members):
Group Contact Person:
City: Region:
Phone number: landline Cell phone:
Group Contact person e-mail:
Youth CSO CATEGORY
Legal name of Organization:
Contact person information:
City: Region:
Phone number: landline Cell phone:
e-mail:
  1. Nominator information

Please fill out your personal data and contact information in this section

Nominator’sName:
Address:
Institution/ Organization (if applicable):
Position/workplace:
City: Region:
Phone number: landline Cell phone:
e-mail:
  1. Please describe in what capacity do you know the nominee(s)? (maximum 600 characters)
  1. In no more than 2 pages, please outline how the nominee (s) has/have made a contribution to the community or/and society in Macedonia through active civic engagementin the period January-December 2017.Include the following:

A)Describe the main activities, initiatives implemented by the nominee (s):

B)What issues of public concern in Macedonia were addressed through the nominee (s) activities or initiatives:

C)Describe the impact, achievements and the beneficiaries of his/her/their work:

D)In your own words, please describe in the best way you can, why should the nominee (s) recieve this years Youth Civic Engagement Award?:

  1. References

Please, provide the names, titles, phone numbers, and email addresses of three other persons that know at a certain degree of detail about the nominee(s)’ civic engagement work.

  1. Supporting documents

Please, send in examples of the Nominee's work (e.g.Links, videos, photographs, books, articles, etc.). These supporting materials should not exceed 5 (five) pages.

Videos related to the nominnes work should be:

-uploaded to YouTube (with the link included in the application) or provided to NYCM on a CD, and;

-if provided on a CD, videos must be in .wma, .wmv., .avi, .mpg, .wav, or any other video file type supported by Windows Media Player.

  1. Disclaimer and signature

I certify that the information provided is true and complete to the best of my knowledge.

Signature: ______Date: ______

Thank you for your nomination!

USAID CIVIC ENGAGEMENT PROJECT IN MACEDONIA – (CFN) # CEP-YCEA-02