Make a Nomination as an Accredited Social Science Society 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 Proposer SocietyPlease read “How can Learned Societies make Nominations” in the Nominations Guidelines before completing this section. Contact details of the Society representative making the nominationTitle *First name *Surname *Job TitleName of Nominating Body *Position in Nominating BodyAddress (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 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: 4. 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