UAE Nomination Form

WaterWipes Pure Foundation Fund nomination form for healthcare professionals nominating yourself or other healthcare professionals.

NOMINATION TYPE*

I am a UAE healthcare professional nominating myself

I am a UAE healthcare professional nominating another healthcare professional

YOUR DETAILS

(e.g. Hospital/Practice/Unit/Clinic)

Please note: Click here to read the terms and conditions in full, including submission details, deadline, bursary fund information and judging criteria.* By submitting your nomination, you agree in full to these terms and conditions.

(Optional) I consent for my name and nomination entry, to be used in social media/marketing activities relating to the Pure Foundation Fund.

YOUR NOMINEE'S DETAILS
(Not required for self-nominations)

(e.g. Hospital/Practice/Unit/Clinic)

NOMINATION STATEMENT

MANDATORY: Please summarise how you/ or the individual contributed to improved medical practice and/or outcomes for babies and their families. Please also provide information on how you / the individual have gone above and beyond to provide an exceptional level of maternity, neonatal or postnatal care.
(approx. 500 words / 4000 characters)

(Note: Form won't submit if the character limit of 4000 is exceeded)

OPTIONAL: If your entry was selected as the winner, please provide details on what would the bursary fund would be used for if known? (approx. 100-200 words )

The nomination deadline is December 6th, 2020.

For full terms and conditions, please click here.

For information on the initiative, please click here

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