Maxton Scotland
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Young Achievers Award 2011


NOMINATION FORM 2011

Recognising inspirational young people who’ve made a difference through their volunteer efforts in the arts, community, environment and sport during the past 12 months.

Please note:
ρ All sections of this form must be completed as fully and clearly legible as possible.
ρ Supporting material will not be considered.
ρ If you’re nominating yourself, you will need to fill in the details of a sponsor or fellow volunteer or organisation who can verify your activities.
ρ Nominations must be for individuals who live in England, no group or international nominations will be considered.
ρ Please note that the closing date for nominations is 12th November 2011.

I WOULD LIKE TO NOMINATE THE FOLLOWING PERSON AS A YOUNG ACHIEVER:
(You must obtain permission from the nominee before submitting the form)

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


1 – NOMINEE CATEGORY

¨ Young Arts Achiever

¨ Young Community Achiever

¨ Young Environment Achiever

¨ Young Sport Achiever


2 – NOMINEE


¨ Male

¨ Female


Title:

Name:

Address:

Postcode:

Email:

Telephone:

Date of Birth: Age (at application):


3 – NOMINATOR/SPONSOR

¨ I am a nominator. Here are my details:


¨ I am self-nominating. These are my sponsor’s details:

Title:

Name:

Address:

Postcode:

Email:

Telephone:

Job Title:

Organisation:
Relationship to Nominee:


4 – BACKGROUND INFORMATION

This is your chance to tell us why your nominee should win a Young Achievers Award.

Please provide as much relevant information as possible in no more than 200 words per question. Please do not submit other supporting material as this will not be considered.

4.1 Describe the activity carried out by the nominee over the last 12 months.
E.g. what have they been doing, how did they become involved, how much time spent on it, skills used?


4.2 What makes the nominee and his/her achievement so special?
E.g. has the nominee demonstrated creativity or innovation or inspired others to volunteer? How has the nominees life changed as a result of the activity?


4.3 What wider community benefit or impact has the nominee’s activity had?
E.g. have they created change in their community or raised awareness of an issue?


5 – HOW AND WHERE DID YOU HEAR ABOUT YOUNG ACHIEVERS?

5.1 Which organisation/newspaper/publication?
Please specify:
_________________________________

5.2 What method?

¨ By printed flyer

¨ By e-flyer

¨ By email

¨ Via a website

¨ By word of mouth

¨ Through membership of an organisation
please specify:
_______________________________________

¨ I would like to receive more information about the Young Achievers Trust.

¨ I confirm that to the best of my knowledge, all information on this form is correct, that I understand and abide by all terms and conditions, that the nominee has agreed to be
nominated and for their details to be used in publicity.


Signature: ___________________________(please type your name if e-mailing)

Date: ___________

____________________________________________________

Once completed please e-mail to info@youngachievers.co.uk.

Alternatively, please post your application in an envelope clearly marked “YA Awards” to:

C/o Caroline Murray
Young Achievers Trust
123 Whitecross Street
London
EC1Y 8JJ

Thank you for entering – we look forward to reading your application.

You may also email any queries to info@youngachievers.co.uk.

___________________________________________________

Back to: Maxton Parish Noticeboard

Date: 05/10/2011