Community Hearts Awards



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Community Hearts Awards





(Please write clearly)




1. NAME OF INDIVIDUAL OR SMALL GROUP BEING NOMINATED.
a) Name of individual/or Lead person in group :……………………………………………………………………………………….


  1. For all categories of nomination:


Address: …………………………………………………………………………………….
……………………………………………Post Code ………...……………….
d) Tel no: ……………………………………………………………………….……………

e) Email Address: ……………………………………………………………………………

f) Being nominated for which category:- ( see Guidance and criteria)

…………………………………………………………………………………………………….














2) PLEASE TELL US ABOUT THE CONTRIBUTION THIS PERSON OR GROUP HAS MADE TO THE COMMUNITY (you may add one additional side of A4)

(how long the individual or group has been working, Range / variety of voluntary work, any special challenges overcome, evidence of innovation, creativity, and commitment, achievements, impact in the community)





3. NOW PLEASE TELL US ABOUT YOU (The Nominator).
a) Your name: ………………………………...………………………………….……………….
b) Your address: …………………………………………………………………………………….
Post Code ………...………………. Telephone no: ……………….………………………………
d) Email Address: ………………………………..…………………………………………………

e) Are you related to the individual / anyone in the group you are nominating?

Please tick Yes No






f) In what capacity do you know the individual or group that you are nominating?

g) How long have you known the person / group you are nominating?

h) Have you gained the agreement of the person / group you are nominating?

Please tick Yes No












Your Signature : ……………………………………………..……………………………

Date: ………………………………………………………………………….





Please ask one other resident of the city ward/Exceed schools to indicate their support for this nomination (this person should not be related to the nominee or on the management committee of the group).

I support this nomination:-

1) Signature: ……………………………………………………………………………………
Name (block letters): …………………………………..…………………………………..
Address: ………………………………………..………….………………………………..
……………………………………………….. Post Code ………..………….

Completed application forms should be returned to
Nadia Hussain

Exceed

Horton Grange Primary School

Spencer Road Bradford BD7 2EU

n.hussain-exceed@hotmail.co.uk



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