Contact Us – Youth Bridge Kenya

INFORMATION ON THE NOMINEE

Title *

Surname

Other Names

Position/ Title/ Rank (If any)

Passport Number

Date of Birth

Nationality

Organization

Email Address (If Any)

Telephone Number

Mobile Numbers

Nomination Category

Nomination Category *a) Young Exceptional Africanb) Young Outstanding Africanc) Iconic Youth Champion

Record of Innovation/Public/Community Service or role in national development

Previous Awards of Honour

Citation (grounds for nomination)

Please state what the nominee has achieved which makes them stand out

Please list any other ways in which the nominee’s contribution has been recognized elsewhere (for example in the media, by other awards, professional/interest groups)

DETAILS OF PERSON/BODY MAKING THE NOMINATION

Title *

Surname

Other Names

Designation/Rank (where applicable)

Organization

Address

Email Address

Telephone Number

Mobile Number

confirm *I confirm that the information given above is true to the best of my knowledge and understanding

Date