About Nominations

Fukuoka Prize Online Nomination Form

Entry
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Completion

Please enter your nomination

Categoryrequired	Please select your Selection Academic Prize Arts and Culture Prize
Is the nominee an individual or a group and organization?required	Individual Group/ Organization
Name of the candidate or a group and organizationrequired
Nationality of the nominee
Gender of the nominee（※for idividual nominee only)	Male Female I would like not to mention.
Date of birth of nominee（※ date of establishment for group or organization）	Please select a year. Please select a month. Please select a day.
Affiliation and occupation （※ individual nominee only）
Field of specialization
Reasons for nomination（within 200 words）required
Career, list of awards and etc. (within 1500 words)
Website URL regarding your nominee

Nominator Details

Please provide the following information about yourself as a nominator. As for your information, the secretariat shall keep its confidentiality.

Namerequired
Affiliation and occupation required
Field of Specialization / Brief Profile

contact information

Post code
Countryrequired
Address1required
Address2
Building and appartment
email addressrequired
email address ( for confirmation )required

※Please note that we will contact you preferentially via email.

※Please be advised that we may contact via email address given above if we have any enquiries regarding with your nomination detail.

Would you be able to participate as a nominator in the future?	Please tick the box if you could kindly participate as a nominator of the Fukuoka Prize in the future. Please be advised that we may send you an email for nomination request. I can continue to participate as a nominator in the future. I can continue to participate as a nominator in the future.

Attention

Please fill in all the required fields. Please fill in as much as fields possible even if they are not required.

※Please complete the form in English.
※No self-nomination is permitted.

We would accept the list of information relating to your nominee's articles, C.V., academic thesis, and publications. Please send the list via email attachment or post them to our postal address.

Contact information

email address	f.prize[@]io.ocn.ne.jp Please remove [] and send when contact us.
FAX	092-735-4130
Address	〒810-8620 c/o International Affairs Dept., General Affairs & Planning Bureau, Fukuoka Secretariat of the Fukuoka Prize Committee

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