Nomination Form

Full Name of Nominee (Surname first): *
Gender (This is to inform the comprehensive health screening):
Affiliated media organization
Nominated by (Please indicate if self nomination):
Number of years as a journalist:
Number of years working with present affiliate organization:
Number of articles submitted
Period covering (Must be a 1-year record counting backwards from nomination date):
How did you hear about the Journalist cancer control advocate award?
As a journalist (Please ignore if not a journalist), what does being a cancer control advocate mean to you (100 words maximum)?
Why does your nominee deserve to win this award (100 words maximum)?
Please mention 3 ways the media can be encouraged to support cancer control advocacy in Nigeria.

Thank you for your nomination. We wish you all the best.

Kindly mail scanned proofs of your 1-year portfolio to us.

Please note that all submissions must acknowledge the actual names of the nominees to be counted towards the particular nominee.