Social Innovation Fellows Program

Thank you for taking the time to nominate an individual to the Pop!Tech Social Innovation Fellows Program. Self-nominations are also accepted.  The information you provide will prove invaluable to our selection committee as they do their utmost to bring together a highly diverse and talented group of social innovation fellows.

Nominator Information   What is your name?* What is your profession?* What is your affiliation to the Pop!Tech Network?* Choose.. Participant Participant Grant Awardee Past Fellow Speaker Sponsor Volunteer Other No Affiliation Explain:   What is your daytime telephone?* Your email address?* Fellow Nominee Information   Title* Choose.. Mr. Mrs. Ms. Dr. Name* Address* City* State/Province* ZIP/Postal Code* Country* Age range* Choose.. 21 – 24 25 – 34 35 and over   Email address Website Daytime phone* Nominee Profile   Can you tell us a little bit about the person you wish to nominate, including why you feel they would be an ideal candidate for the program?* (max 4000 characters)   What is the area of focus of the nominee?* Choose.. Agriculture Education Energy The Environment Global Health Care Human Rights Advocacy International Development Journalism Media / Film Technology Other Explain:   Can you give a brief description of the nominee’s work?* (max 4000 characters)   What are some of the outcomes/impacts of this work?* (max 4000 characters)   Tell us about any awards or recognition the nominee has received. Please provide us with as much information as you can.* (max 4000 characters)   Is there anything else you would like to share to help us to better understand the nominee? (max 4000 characters)     Thank you for your nomination! If you have any questions about the Pop!Tech Social Innovation Fellows Program, please email fellows@poptech.org.

Download the Fellows Nomination Form 

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