Nomination Form 2016/17 Please use this form to nominate a young person for any of the seven Celebrate Success Awards categories. Before you begin to complete the form, please read the Nominations Guidance document. It contains essential information to help give your nomination the best chance of success. You will find it difficult to complete this form without the Guidance. Deadline The deadline for nominations is Friday 17th June 2016. Award Categories Please choose (tick) the categories for this nomination. You can nominate in up to two categories, but please make sure you meet the eligibility criteria for each of them, as set out in the Nominations Guidance: Educational Achiever Breakthrough Award Rising Star Award Community Impact Award Enterprise Award Young Ambassador of the Year Young Achiever of the Year 1/9
Nominee s Details Name Date of Birth Home Address Postcode Daytime Telephone Mobile Number Email Address Nominator s Details Nominator s Name Relationship to nominee Job Title Organisation Address Postcode Daytime Telephone Mobile Number Email Address 2/9
Champion(s) Details Champion 1 The nominator is automatically a Champion. If you would prefer not to be included as a champion, please tick here Champion 2 Name Job Title Organisation Address Postcode Daytime Telephone Mobile Number Email Address Relationship to nominee Please tell us in one sentence how the Champion has supported the nominee Please tick here to confirm that this person is happy to be put forward as a Champion 3/9
The Nominee s Journey Celebrate Success recognises the achievements of young people, overcoming whatever barriers or difficulties they have in their lives; flourishing with support from The Prince s Trust and moving towards a more successful future. This is the most important part of the form, because it s where you bring the nominee s story to life. Be sure to read the Nominations Guidance for the category/s you are entering because it contains lots of useful information. a) Before The Prince s Trust 4/9
The Nominee s Journey b) During their time with The Prince s Trust 5/9
The Nominee s Journey c) Now and the future 6/9
In Their Own Words If you have a quote from the nominee or someone else involved in their journey, please provide it here. Sum it Up If you were writing an article for a local newspaper about your nominee s success, what would the headline be? One More Thing If you have any further material, which may strengthen your nomination, please attach it with the nomination form. 7/9
Past Offences The Prince s Trust is proud to support young offenders to move forward with their lives. However, due to the high profile nature of our Celebrate Success Awards, it is important that we are aware of issues the nominee has had with the law. If the nominee has a criminal record, or if there is a risk of a victim or anyone from their past coming forward to discredit their story, please let us know. What was the nature of the incident? Was the nominee sentenced? If so, how long for? When did the incident take place? Were other people involved and/or affected? If the nominee has been in trouble with the law for a high-profile, serious or violent offence, please speak to your local Prince s Trust contact or Press Officer before nominating. Confidentiality The wellbeing of our young people is our number one priority. If there is any information included in your nomination that is sensitive, which the young person would prefer not to to be disclosed beyond the judging panel, please tell us here: If no information is included in this section, The Prince s Trust will assume all parts of your nomination can be disclosed beyond the judging panel. 8/9
Data protection Your contact details will only be used by The Prince s Trust and third parties involved in the promotion/delivery of Celebrate Success. We will not disclose or sell your details to any external organisations. Consent - to be completed by the nominator Please tick this box to confirm that you have spoken to the nominee about this Award and the Celebrate Success process and they are happy to be included as an entrant. Please tick this box to confirm that the nominee is happy for their approved story, including their photo and any direct quotes, to potentially be used for promotional purposes by The Prince s Trust or third parties involved in the promotion of Celebrate Success. Please tick this box to confirm the nominee (and their parent/guardian for under 16s) understands that Celebrate Success is a public-facing event and is happy that their approved case study, photo and any direct quotes, could potentially appear in the press, for example local or national newspapers and online media. Confirmation I, the nominator, confirm that all of the information included in this nomination form is accurate and correct to the best of my knowledge and, if applicable, I have not withheld any information about the nominee s previous offences. Signed: Thank You For Nominating. Please return this form to your local Prince s Trust office (details can be found in the guidance note), along with any supporting evidence, if applicable. If you have any problems completing this form please speak to your regional Celebrate Success Nominations co-ordinator. DSN 3264-2 The Prince s Trust 2016 all rights reserved. The Prince s Trust is a registered charity, incorporated by Royal Charter (RC000772). Principal office: Prince s Trust House, 9 Eldon Street, London, England EC2M 7LS. Registered charity number in England and Wales (1079675) and Scotland (SC041198). 9/9