Emerging Leadership Award nomination form

Please complete this form to nominate a mover and shaker for the 2021 Emerging Leadership Award. This award celebrates an inspiring leader who:

has taken on a career challenge, career move or career change within the last 2-4 years that has high potential for industry impact
exhibits leadership qualities such as strategic risk-taking, embracing innovation, entrepreneurship and an appetite for driving change
is a rising star, who, regardless of age, is seen as a mover and shaker with high potential for future success in the industry

<< Back to the 2021 Women in Leadership Awards page

2021 Emerging 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 - Emerging Women in Leadership

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 is the career move, challenge or change that this person has taken on within the last 2-4 years? What is the potential for industry impact? *

Max. 250 words

What is it about this person that demonstrates their leadership potential? How will their leadership qualities position them for future impact? *

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