၂ဝ၁၇ ခုႏွစ္တြက္ အမည္္စာရင္းတင္သြင္းျခင္း ပိတ္ပါၿပီ။ (မွတ္ခ်က္။ ။အမည္စာရင္းတင္သြင္းျခင္း ပိတ္ရက္ ဧၿပီလ ၂၃ ရက္ ၂၀၁၇ ခုႏွစ္) Sorry, Nomination for 2017 is now closed. (Since last day of submission is Sunday, April 23, 2017)
  1. မိမိ၏အမည္ (Your Name)(*)
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  2. မိမိ၏လိပ္စာ(ၿမိ့ဳ၊ ျပည္နယ္၊ ႏိုင္ငံ) (Address)
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  3. မိမိ၏အီးေမးလ္ (Your Email Address)(*)
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  4. အဆိုျပဳလိုသည့္လူမွဳလုပ္ငန္း(သို႔မဟုတ္)ေစတနာ့ဝန္ထမ္း၏အမည္ (Nominee's Name)(*)
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  5. ၄င္း၏လိပ္စာ (Nominee's Address)
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  6. ၄င္း ေဆာင္ရြက္ေနသည့္လူမွဳနယ္ပယ္ (Please describe your nominee's specific communal category.)(*)
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  7. ၄င္း၏ ေဆာင္ရြက္ခ်က္မ်ားေၾကာင့္ ထူးျခား၊ ေျပာင္းလဲ၊ ေကာင္းမြန္လာမွဳမ်ား (How have your nominee's efforts made a difference for the better?) (100 word maximum)(*)
    Invalid Input
  8. ၄င္းကို ျပည္သူ႔ဂုဏ္ရည္အျဖစ္ဂုဏ္ျပဳလိုသည့္ မိမိဆႏၵႏွင့္ ခံစားခ်က္ (In your own words, why does your nominee deserve recognition as a Citizen of Burma Award? Please describe in detail your nominee's specific accomplishment and what was involved in achieving it.) (200 word maximum)(*)
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