Drivers of Change Entry Form

Name of Nominee: Category: Business Civil Society Goverment Individual Organisation: Independent NGO Research Institute Faith-based Organisation Development Consultancy Business Trade Union Public Corporation Broad-based Network Community-based Network Social Movement Statutory Agency Individual Multilateral Organisation Campaign Goverment Grant Maker Other Name of Nominator: Postal Address: Tel: Cell: Fax: Email: Physical Address: Description of Organisation:   Description of the organisation being nominated if you are nominating a individual, please give a brief description of the type of work being done by the organisation, its annual operating budget, the total number of people working in the organisation, its approach to doing its business, and any other descriptive information you think might be helpful to the panel of judges in assessing the nomination, if you have an individual who is associated with an organisation, you should briefly describe the organisation in this section. Motivation: Write a motivation of not more than two A4 pages explaining why you believe the organization or individual you are nominating should be recognised as a Driver of Change to overcome poverty in southern Africa.