ALBA-FKNE Diversity Prize 2020 - Nomination Form

Detailed information on the requirements for this call for nominations can be found on the ALBA Network website.

Nominations for the ALBA-FKNE Diversity Prize 2020 must be submitted through this online form by 1st March 2020 (23:59, Brussels time/CET) at the latest.
Nomination Type *

I am nominating myself I am nominating someone else I am nominating a group

Proposer Full Name *

Title First Name Last Name
Proposer E-mail *

Affiliation/ work address of the Proposer *

University or Institution
Department
City	Laboratory (if relevant)
Postal / Zip Code	Country

Proposer Position

Nominee's Full Name *

Title First Name Last Name
Nominee's Email *

Affiliation/ work address of the Nominee *

University or Institution
Department
City	Laboratory (if relevant)
Postal / Zip Code	Country

Nominee's Position *
Relevant Weblink

Name & address of the group nominated. If different from Proposer's affiliation

Institution/Group Name
Department
City	Laboratory (if relevant)
Postal / Zip Code	Country

Relevant Website *

If group contact person is different from proposer:
Group contact person's Name, if different from Proposer's

Title First Name Last Name
Group contact person's E-mail, if different from Proposer's
example@example.com
Group contact person Position, if different from Proposer

Upload a statement indicating how the nominee or group promotes diversity in brain sciences *
PDF only. Max 1 page.
Comments (optional)
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