Inspiring Leadership Award nomination form

Please complete this form to nominate someone who is making it happen for the 2021 Inspiring Leadership Award. This award celebrates an inspiring leader who:

has played a pivotal leadership role in delivering a project, partnership, or collaborative initiative within the last 5 to 10 years
through this project or initiative has delivered meaningful outcomes and positive change in the health industry
has demonstrated valuable leadership skills such as collaboration, communication, team building, transformation, innovation, change management, dedication and passion for innovation that has impact

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2021 Inspiring Leadership Award nomination form

Nominator's details

Nominator's title Nominator's title

Nominator's first name *

Nominator's last name *

Nominator's organisation *

Must be from a BioMelbourne Network member organisation

Nominator's email *

Nominator's contact phone number *

Nominee's details

Nominee's title Nominee's title

Nominee's first name *

Nominee's last name

Nominee's position title *

Nominee's organisation *

Must be from a BioMelbourne Network member organisation

Nominee's email address *

Nominee's contact phone number *

Mobile number preferred

Nomination details

Please describe how the nominee meets each of the following criteria. Responses should be no longer than 250 words. Where possible, provide examples to support your statements.

What was the project or initiative that this leader has played a pivotal role in delivering? What success did it achieve and what difference has it made? *

Max. 250 words

What is it about this person that makes them a successful leader of this project or initiative? How did they make it happen? *

Max. 250 words

Is there anything further that you would like to add to support your nomination? (optional)

Nominee's two-page CV *

Maximum file size: 516MB

You can upload any additional supporting documentation here (optional)

Maximum file size: 516MB