BASIC INFORMATION
VERIFICATION
ACKNOWLEDGEMENT
1/3
TYPE / JENIS
Organisation / OrganisasiIndividual / Individu
NAME / NAMA
BASIC BACKGROUND/LATAR BELAKANG RINGKAS*
WEBSITE(IF ANY) / LAMAN SESAWANG(JIKA ADA)
SOCIAL MEDIA(IF ANY) / MEDIA SOSIAL(KALAU ADA)
CATEGORY (PLEASE CHOOSE ONLY ONE) / KATEGORI (SILA PILIH SATU SAHAJA) Animal & WildlifeEducation AdvancementArts,Culture & HeritageDisaster ReliefHealth ServicesEnvironmental ProtectionHuman EmpowermentPublic SafetySocial InnovatorPoverty & Hunger ReliefCSR Individual Champion
Q1. Specify the estimated number of rescued / assisted / adopted animals.
Q2.Specify the number of animals treated (Please provide proof)
Q3.Specify initiatives taken to preserve any natural habitat or wildlife. (Please provide proof).
Q1. Specify the number of classes/sessions/ workshops conducted.
Q2. Specify the number of people / participants involved (Please provide proof).
Q3.Specify the types of classes/sessions/ workshops conducted.
Q4.Describe the impact of your classes/sessions/ workshops in terms of outcomes. (Please provide proof).
Q1.Specify the number of classes/sessions/workshops conducted OR related promotional activities (Please provide proof).
Q2.Specify the types of classes/sessions/workshops.
Q3.Specify the collaboration partners that you have worked with. (List all the partners)
Q4.Specify any initiatives at art, cultural and heritage preservation.
Q1.Specify the number of times you have volunteered to affected areas.
Q2.Specify the types of classes/sessions/workshops conducted (Please provide proof).
Q3.Specify the collaboration partners that you have worked with. (List all the partners) (Please provide proof).
Q1.Specify the number of times you volunteered in health services activities.
Q2.Specify the types of health services activities that are of your own initiative.
Q3.Specify the health practitioners or organisations that you worked with (Please provide proof).
Q1.Specify the number of public awareness campaigns / programs organised (Please provide proof).
Q2.Specify the types of awareness campaigns / programs organised or initiated.
Q3.Specify the collaboration partners that you have worked with. (List all the partners).
Q1.Specify the type of programs and activities organised.
Q2.Specify the number.
Q3.Describe the impact of your programs or activities. (Please provide proof).
Q1.Specify the category / cause that you have championed.
Q2.Specify the frequency of your advocacy (please provide proof).
Q3.Specify the number of beneficiaries.
Q1.Specify the innovation that you have created to solve social challenges (please provide proof).
Q2.Specify the number of years your innovative solution has been implemented.
Q3.Describe the impact.
Q1.Specify the number of individuals / families assisted (please provide proof).
Q2.Describe the service rendered. (Please provide proof).
Q2.How many individuals/families have you assisted with employment opportunities?
Q3. Describe the impact
TYPE OF ASSISTANCE/JENIS BANTUAN * AWARENESS / KESEDARANMONETARY AID / BANTUAN KEWANGANEMOTIONAL AID / BANTUAN EMOSIFOOD AID / BANTUAN MAKANANTRAINING AND EDUCATION / LATIHAN DAN PENDIDIKANPHYSICAL AID / BANTUAN FIZIKALVOLUNTEERISM / SUKARELAWAN
WORK WITH POLITICAL PARTIES? / BERKERJASAMA DENGAN PARTI POLITIK? * YES / YANO / TIDAK
I verify that the information on this nomination form is true and correct / Saya mengesahkan bahawa segala maklmuat dalam borang pencalonan ini adalah sahih dan benar. *
YES / YANO / TIDAK
PHONE / TELEFON
EMAIL / EMEL
RELATIONSHIP / HUBUNGAN
IMSHA Secretariat acknowledges this nomination and will forward it to the next stage which is the Research Process that will involve a two-stage shortlisting mechanism:
Stage I: Nominations are required to include brief background information and justification on why they deserve to be nominated.
Stage II: Shortlisted nominations will then be requested to provide additional detailed information.
For more information, please email socialheroawards@gmail.com
Thank you for your time in nominating your social hero!
——————————————————————————————
Sekretariat IMSHA mengaku bahawa pencalonan ini diterima dan akan dimajukan kepada peringkat seterusnya iaitu Proses Penyelidikan yang akan merangkumi mekanisme penyenarai-pendekan dua peringkat:
Peringkat I: Semua pencalonan dikehendaki menyertakan maklumat later belakang ringkas dan juga justifikasi hak pencalonan. Peringkat II: Maklumat terperinci akan diminta bagi pencalonan yang telah disenaripendek. Untuk maklumat lanjut, sila emel ke socialheroawards@gmail.com
Terima kasih kerana meluangkan masa untuk mencalonkan hero sosial anda!
I ACKNOWLEDGE THE ABOVE STATEMENT.
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MORE INFORMATION
1/4
WEBSITE(IF ANY)/LAMAN SESAWANG (KALAU ADA)
SOCIAL MEDIA(IF ANY)/MEDIA SOSIAL(KALAU ADA)
CATEGORY (PLEASE CHOOSE ONLY ONE) / KATEGORI (SILA PILIH SATU SAHAJA) Animal & WildlifeEducation AdvancementArts,Culture&HeritageDisaster ReliefHealth ServicesEnvironmental ProtectionHuman EmpowermentPublic SafetySocial InnovatorPoverty & Hunger ReliefCSR(Company)
Q1.Specify the estimated number of rescued / assisted / adopted animals.
Q2.Specify the estimated number of animals treated (Please provide proof).
Q1.Specify the number of classes/sessions/ workshops conducted.
Q2.Specify the number of people / participants involved (Please provide proof).
Q2.Specify the types of classes/sessions/ workshops.
Q1.Specify the number of deployment to affected areas.
Q2. Specify the types of aid provided.
Q3.Specify the types of classes/sessions/ workshops conducted (Please provide proof).
Q4.Specify the collaboration partners that you have worked with. (List all the partners) (Please provide proof).
Q1.Specify the number of medical examinations, medical screening, talks, public awareness campaigns and support to specific health issues being mental or physical conducted (Please provide proof).
Q2.Specify the number of people who attended or assisted.
Q3.Specify the collaboration partners that you have worked with (List all the partners) (Please provide proof).
Q2. Specify the type of programs or campaigns carried out.
Q3.Describe the impact of your programs or campaigns. (Please provide proof).
Q4.Specify the collaboration partners that you have worked with. (List all the partners)
Q4.Specify the number of people / participants involved (Please provide proof).
Q1.Specify the number of victims / communities assisted
Q2.Specify the number of awareness campaigns conducted (Please provide proof).
Q3.Specify the collaboration partners that you have worked with
Q1.Specify the innovation that you have created to solve social challenges (Please provide proof).
Q3.Describe the impact
Q1.Specify the number of individuals / families assisted (Please provide proof).
Q1.Specify the number of individuals / families assisted.
Q2.How many individuals/families have you assisted with employment opportunities (Please provide proof)?
Q3.Specify the collaboration partners that you have worked with (List all the partners)(Please provide proof)
Q1.Specify the types of CSR programs conducted (Please provide proof).
Q2.Specify the number of CSR programs conducted (Please provide proof).
Q3.Describe the impact. (Please provide proof).
Q4.Specify the collaboration partners that you have worked with (List all the partners) (Please provide proof).
TYPE OF ASSISTANCE/JENIS BANTUAN* AWARENESS / KESEDARANMONETARY AID / BANTUAN KEWANGANEMOTIONAL AID / BANTUAN EMOSIFOOD AID / BANTUAN MAKANANTRAINING AND EDUCATION / LATIHAN DAN PENDIDIKANPHYSICAL AID / BANTUAN FIZIKALVOLUNTEERISM / SUKARELAWAN
ATTACH A COPY OF YOUR LATEST AGM MINUTES OF MEETING/SERTAKAN SALINAN MINIT MESYUARAT AGM TERKINI ANDA*
COMPILATION OF SOCIAL MEDIA UPDATES ON ACTIVITIES (IF NO MINUTES AVAILABLE) /KOMPILASI KEMASKINI MEDIA SOSIAL MENGENAI AKTIVITI (JIKA TIADA MINIT MESYUARAT)
REGISTERED WITH ROS/ BERDAFTAR DENGAN ROS?* YES / YANO / TIDAK
UPLOAD A COPY OF YOUR ROS CERTIFICATE OF INCORPORATION/ MUAT NAIK SALINAN SIJIL ROS ANDA*
YEAR ESTABLISHED/TAHUN DITUBUHKAN*
HAVE AN OPERATION PREMISE? / MEMPUNYAI PREMIS OPERASI?* YES / YANO / TIDAK
