Make a Nomination as a Fellow Please read the full guidance notes carefully before completing this form. View the guidelines 1. The NomineeNominees must be eminent in their fields and may be drawn from academia, public, private or third sectors. They must also have made a substantial contribution to wider social science beyond the normal requirements of their position. It must be clearly demonstrable that they merit the esteem of their peers. Proposers must not belong to the same institution as, or be closely related to, the Nominee. Neither may they have worked closely with the Nominee in recent years. Please read further, detailed information in the section “What makes a suitable nominee?” in the Nominations Guidelines before completing this section. Personal details of the nomineeTitle *First Name *Other InitialsSurname *Position / Job Title Position / Job Title Job title as it should appear on the Conferment Announcement if this nomination is successful e.g. ‘Professor of Social Science’ or ‘Senior Analyst’ Organisation / Employer *Address (First Line)Address (Second Line)Town / CityCountyCountry- Select -United KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia-HerzegovinaBotswanaBouvet IslandBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Democratic Republic of the (Zaire)Congo, Republic ofCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupe (French)Guam (USA)GuatemalaGuineaGuinea BissauGuyanaHaitiHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory Coast (Cote D`Ivoire)JamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartinique (French)MauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew Caledonia (French)New ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPolynesia (French)PortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-Leste (East Timor)TogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin IslandsWallis and Futuna IslandsYemenZambiaZimbabwePostcodeEmail *TelephoneNominee Consent The nominee is expected to have given consent to this nomination. Would the nominee accept Fellow status if offered? (Please mark the box to confirm) 2. The ProposerProposers must belong to a different institution or organisation from the Nominee. Oxford and Cambridge colleges do not count as separate institutions. Please read “Who can propose and second a nomination” in the Nominations Guidelines before completing this section. Contact details of the Fellow making the nominationTitle *First name *Other initialsSurname *Position / Job TitleOrganisation / Employer *Address (First Line)Address (Second Line)Town / CityCountyCountry- Select -United KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia-HerzegovinaBotswanaBouvet IslandBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Democratic Republic of the (Zaire)Congo, Republic ofCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupe (French)Guam (USA)GuatemalaGuineaGuinea BissauGuyanaHaitiHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory Coast (Cote D`Ivoire)JamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartinique (French)MauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew Caledonia (French)New ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPolynesia (French)PortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-Leste (East Timor)TogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin IslandsWallis and Futuna IslandsYemenZambiaZimbabwePostcodeEmail *TelephoneSignature Signature * Signature Confirmation * By checking this box, you confirm that all the information you are submitting is accurate at the time of the nomination being made. Date3. The SeconderThe Academy requires all nominations put forward by a Fellow to be seconded by another Fellow. Seconders may belong to the same institution as the Nominee. Contact details of the Fellow seconding the nominationTitle *First Name *Other InitialsSurname *Position / Job TitleOrganisation / Employer *Address (First Line)Address (Second Line)Town / CityCountyCountry- Select -United KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia-HerzegovinaBotswanaBouvet IslandBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Democratic Republic of the (Zaire)Congo, Republic ofCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupe (French)Guam (USA)GuatemalaGuineaGuinea BissauGuyanaHaitiHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory Coast (Cote D`Ivoire)JamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartinique (French)MauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew Caledonia (French)New ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPolynesia (French)PortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-Leste (East Timor)TogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin IslandsWallis and Futuna IslandsYemenZambiaZimbabwePostcodeEmail *TelephoneSignature Signature * Signature Confirmation * By checking this box, you confirm that all the information you are submitting is accurate at the time of the nomination being made. Date4. TestimonialHow many years have you known the Nominee? *In what capacity do you know the Nominee? (Please tick all that apply) In what capacity do you know the Nominee? (Please tick all that apply) * Personally Professionally By reputation Other, please state below… 5. The Statement of JustificationThe Statement of Justification must be completed by the Proposer. Please read the Section headed ‘The Statement of Justification’ in the Nominations Guidelines and look at the example statements, before completing this section. Please ensure you: Indicate why the Nominee is eminent in his/her field. Outline the main impact of the Nominee’s work, citing significant publications, if relevant and appropriate. Show the Nominee’s contribution to wider social science. This should be presented as a short series of evidenced bullet points that make the case (max 500 words). All relevant information must be included in this submission – either here or within the associated CV, and you should not refer to information elsewhere, for example, on a website. Upload Statement File name: File size: 6. CVPlease upload a short, summary CV (maximum length: 4 pages) ensuring that the nominee’s name is included in the CV’s file name. Please refer to the nominations guidance and CV examples. Upload CV File name: File size: Remember to please ask your nominee to complete the Diversity Monitoring Form. Submit