St David Awards 2015 Celebrating and recognising the extraordinary achievements of people in Wales NOMINATION FORM Read the guidance Notes for Nominators which comes with this form before starting to fill it out. Complete all sections of the form or we will be unable to consider your nomination. Nominee the person or group you are nominating I nominate the following person/group for a Welsh Government St David Award: Award Category Please tick the box for the award category for which you are nominating them. (please tick one category only you may nominate in more than one category but please use a separate form each time you do so): 1 Bravery 2 Citizenship 3 Culture 4 Enterprise Nominee contact details 5 Innovation and Technology 6 Sport 7 International 8 Young Person Please include these details only if you know them. If you are nominating a group supply the name of the leader/chair/coordinator/manager etc. Title... First Name... Surname me... Male Female Address...... Post Code... Contact Phone Number... Their age: Under 18 25 34 35 49 50 64 65 + Email... Digital or Social Media Handles e.g. Twitter, Facebook page, YouTube clips etc 1
Your recommendation Explain how your nominee has made a significant contribution in their award category for Wales. Use up to 750 words in either bullet point form or free text. Text box on next page if required 2
Your recommendation (continued) Background Links optional Please detail here any links or websites where the work or activities of the person or group you are nominating can be viewed (optional) e.g. LinkedIn, Facebook, YouTube, personal or organisational website, news-sites etc. which we can use if a nominee is shortlisted. This can be in addition to any optional Letters of Support you might wish to send us as well. 3
Nominator your details Please include these details to the best of your knowledge. They will help us contact you should your nominee be successfully shortlisted. Title... First Name... Surname... Male Female Address...... Post Code... Contact Phone Number... Your age: Under 18 25 34 35 49 50 64 65 + Email... Is your nominee a: Family member Colleague Friend Other If Other please specify Where did you hear about the St David Awards? Please tick the relevant box: Welsh Government From a friend or colleague From a member of my family Through my work Newspaper Television Radio Email circular Social media Please specify: (Twitter, Facebook etc) Other Please specify: 4
Letters of Support optional You can also submit letters of support endorsing your nominee s contribution from people who are familiar with their achievements, which will be used in helping judge their contribution if they are short-listed. Please send them to us by email or as hard copy with this form or separately (see address below). To help you we have posted a Letter of Support template online on www.stdavidawards.org.uk which you can download and get supporters to fill in and submit to back up your nomination. Any Letter of Support sent us should be clearly marked with the: 1. Name of the Award Category 2. Name of your Nominee 3. The Supporter s name & other details: Name Postal address Email Contact phone number Role in which the supporter has known the nominee (for example, colleague, friend etc) A citation in support You can Email us your Letters of Support as a message or as a scanned.pdf attachment to: stdavidawards@wales.gsi.gov.uk OR send us by post as hard copy, addressing your envelope to LETTER OF SUPPORT [NAME OF NOMINEE] [AWARD CATEGORY] St David Awards Nominations 2015 Welsh Government Cathays Park Cardiff CF10 3NQ Note: We will allow a grace period of two weeks after the deadline for the submission of nomination forms, for supporters to send in any late Letters of Support that they may have requested from third parties i.e. until 11 November 2014. Deadline The deadline for submitting this nomination form is 5.00 PM Tuesday 28 October 2014 For Awards Office use only Date form received:... Reference No:... 5 WG22250_1 Welsh Government Crown copyright 2014