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Application for Nomination (Individual)
*Name
*Date of Birth
*Passport No
*Phone
*Current Address
*City
State
ZIP Code
*Award Category
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Disaster prevention & Relief
Education
Community Service
Dialogue among civilizations
Human Tolerance
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Urban Development
Environment and climate change
Specific Innovation
Poverty Alleviation
Other Related Field
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Current Occupation Information
*Current Employer
*Employer Address
*How long?
*Phone
Email
Fax
*City
State
ZIP Code
*Position
Project Achievements
Summary of project achievements and importance to Award category:
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*Referee
*Title
*Contact
Award Importance to Applicant
Summary of Award importance to applicant and project:
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