Activate Cohort 2020 Fellow Nomination Form

Our team is always on the lookout for talented scientists and engineers interested in making an impact with their technologies.

If you know an excellent candidate for the fellowship please fill out this form to put them on our radar. We will follow up with the referred candidate if it looks like there might be a fit.

1. Your first name *This question is required.

2. Your last name *This question is required.

3. Please select the option that best describes your connection to Activate: *This question is required.

4. First name of the person you are referring *This question is required.

5. Last name of the person you are referring *This question is required.

6. Email address for the person you are referring *This question is required. What email address should we use to contact the recommended applicant? This question requires a valid email address.

7. Please share why this person would make a great candidate for the fellowship. *This question is required.