NOMINATION FORM
We are so excited that this form is the first step in recognising an amazing community champion! Please complete the form in full.. the more detailed the answers the better it is for the Judges. PLEASE NOTE- IF A NOMINEE HAS WON A CATEGORY LAST YEAR. THEY WONT BE ELIGIBLE FOR THE SAME CATEGORY THIS YEAR. THEY CAN HE NOMINATED FOR OTHER CATEGORIES ( this does not apply to the Youth category). If you have any questions please reach out via the contact form on our website, or call 0774 806 7169
Section 1: Category & Nominee Details
Award Category
Please Select
Community Impact Business of the Year
Community Champion - Arts, Culture and Leisure
Community Champion - Health, Mental Health & Wellbeing
Environmental Impact Champion
Outstanding Volunteer of the Year
Unsung Hero
Young Person of the Year
Outstanding Group of the Year
Community Impact Group
Newcomer Group of the Year
Trustee of the Year
2. Nominee type: Individual / Group / Business
3. Nominee name:
4. Organisation / group / business name (if applicable):
5. Nominee Facebook page or group (If known):
6. Nominee contact email (If known):
7. Nominee contact phone (If known):
-
Code
8. Nominee town/area/community served:
Section 2: Nominator Details
9. Your name:
10. Your email address:
11. Your phone number:
*
-
12. Relationship to nominee:
13. How do you know the nominee? [Short paragraph]
Section 3: About the Nominee
14. Describe what the nominee does (role/activity/community work):
15. How long have they been doing this? [Short text]
16. Is this activity voluntary, paid, or mixed? (select one)
Fully voluntary
Fully paid role
Mixed (some paid / some voluntary)
17. If connected to a business or job role, explain how they go above and beyond:
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Section 4: Impact Statement (Core Judging Section)
18. Why are you nominating this person for this Award?
Add as much detail as you can!
20. Who has benefited? (tick all that apply)
Children and families
Young people
Older residents
People with disabilities / additional needs
People facing isolation
People affected by mental health challenges
Local community groups
Wider community / town centre
Environment / green spaces
Other
21. What makes this nominee outstanding/unique?
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Section 5: Confidentiality
30. Does the Nominee know that they have been nominated?
Yes
No
Unsure
Final Confirmation
*
I confirm the details provided are true and accurate to the best of my knowledge.
I understand the information will be used for awards judging and administration and may be shared with judges
All nominees will be announced on July 10th. Are you happy for us to contact the Nominee at this stage?
Yes
No please contact me first
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