2017 DENTON AND JANICE LOTZ
HUMAN RIGHTS AWARD
NOMINATION FORM

Purpose of Award: This award is given for significant and effective activities to secure, protect, restore, or preserve human rights as they are stated in the Universal Declaration of Human Rights or in other declarations on human rights.

Eligibility: The award shall not be given to an organization, but to any individual who is a member of a Baptist church affiliated to a convention, union or association that is a member of the Baptist World Alliance Member Body.

Nominations may be made in any language used by a Member Body of the BWA.

Only completed applications will be accepted.

Nominations must be received by the Baptist World Alliance by Friday, December 16, 2016.

Name of Nominee: __________________________________________________________________

CONTACT INFORMATION FOR NOMINEE

Address: ___________________________________________________________________________

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Email: ____________________________________ Telephone No: ____________________________

BWA Member Body Affiliation: _________________________________________________________

Reasons for Nomination: ______________________________________________________________

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(You may use additional paper, if necessary)

Additional References for Nominee (Kindly provide the names and contact information of 3 to 5 persons who can knowledgably support the nomination.)

1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
4. _______________________________________________________________________________
5. _______________________________________________________________________________

Nomination submitted by: _________________________________________________________

CONTACT INFORMATION FOR PERSON MAKING NOMINATION:

Address: _________________________________________________________________________

_________________________________________________________________________________

Email: _____________________________________ Telephone No: ________________________

Your BWA Member Body Affiliation: ________________________________________________

Return to Baptist World Alliance
              405 N. Washington St.
              Falls Church, VA 22046 USA
              Fax: +1 703 893 5160
              [email protected]

FOR YOUR INFORMATION

Previous Denton and Janice Lotz Human Rights Award Recipients:
Ilie Coada, Moldova (2014); Glen Stassen, USA (2013); Edgar Palacios, El Salvador/USA (2012; Wati Aier, India (2011); Leena Lavanya, India (2009); Dennis Datta, Bangladesh (2008); João and Nora Matwawana, Angola/Canada (2007); Gustavo Parajón, Nicaragua (2006)

BWA Congress Human Rights Award Recipients to date (For Reference):
Jimmy Carter, USA (1995); Saw Simon, Myanmar (2000); Lauran Bethell, USA (2005); Denton Lotz, USA (2010); Corneille Gato Munyamasoko, Rwanda (2015)