2022 Kochon Prize Nomination Form

DISRUPTED BUT NOT DEFEATED - RECOGNIZING TB SERVICES PROVIDERS IN AREAS WITH ARMED CONFLICT

Nominee Information

Nominee Type:

Organization / Network / Programme Name:

Salutation:

First name:

Last name:

Mailing address:

Country:

Phone number:

Email address:

1. Describe the armed conflict, including information on those in conflict and the operating challenges within which TB care and support services are being provided. (10000 characters or less.)

2. Describe the work being done to ensure the continuity of services. (10000 characters or less.)

3. Describe the extent of the effort being made, including the risks being undertaken. (10000 characters or less.)

CHARACTER COUNT LIMIT WILL BE STRICTLY ENFORCED.

Criteria 1: The operating environment;
Criteria 2: The type of efforts made
Criteria 3: The extent of effort used to ensure the continuation of TB services.

Nominator Information:

Type of nominator:

Individual Organization Group of individuals

Organization name:

Salutation:

First name:

Last name:

Mailing address:

Country:

Phone number:

Email address:

Website (if applicable):

Nominator Information: Additional Details

Are you a Stop TB partner?

No Yes

Nominator code:

This code will allow you to return to your nomination to edit it.