Synapse Innovator of the Year Awards -- Nomination Form
This is the nomination form for both the Distinguished Innovator of the Year Award and the Inspiring Young Innovator of the Year award. Nominations are accepted on an ongoing basis throughout the year; however, nominations must be received by no later than 12:00 Midnight on Thursday, August 15, 2019, to be presented in September 2019.

Any member of the public or the University of Prince Edward Island community may submit nominations.  All information submitted on behalf of the nominee will be kept confidential.

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Nominee's Name *
Nominee's Mailing Address (incl. postal code) *
Nominee's Email Address *
Nominee's Company Name(s)  (if applicable) *
Is the nominee under the age of 40? (nominees under the age of 40 will be eligible for the Inspiring Young Innovator award) *
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