The BBC Radio Leeds Thank You Teacher Awards offer you the chance to nominate your most inspirational teacher.

You can only submit one nomination/ teacher but there are seven categories to choose from. Anyone of any age can submit a nomination/ teacher apart from the “My Teacher” category which is open only to those aged 16 and under and for which we need to receive a film submission.

Runners up and a winner will be selected from each of the seven categories and there will also be an overall winner.

The runners up, winners and their nominators will be invited to the Awards ceremony at The West Yorkshire Playhouse on Monday 15 June 2015.

Please complete and return this form with your entry. You can email the form to or post it to BBC Radio Leeds Thank You Teacher Awards, 2 St Peters Square, Leeds, LS9 8AH.

Name …………………………………………………………………………………………..

Address……………………………………………………………………………………………

…………………………………………………………………………………………..

Tel No……………………………………………………………………………………………

Email address……………………………………………………………………………………………

Your date of birth …………………………………………………..

Signed………………………………………………………………… Date ………………

Must be signed by a parent/guardian if you are aged under 18 ………………………………….


Name and contact number of person you are nominating:

………………………………………………………………………………………………………………

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

Please tick which category this person fits into…..

  1. Most Inspirational Teacher – Pre-School

(For the most inspirational pre-school teacher in West Yorkshire)

  1. Most Inspirational Teacher – Primary

(For the most inspirational primary school teacher in West Yorkshire)

  1. Most Inspirational Teacher – Secondary

(For the most inspirational secondary school teacher in West Yorkshire)

  1. Most Inspirational Teacher – Extra Curricular Activities (For the most inspirational teacher of clubs or activities outside of school in West Yorkshire)
  1. Most Inspirational Teacher – Adult Education

(For the most inspirational adult education teacher in West Yorkshire)

  1. Most Inspirational Teacher – Special Needs

(For the most inspirational special needs teacher in West Yorkshire)

  1. My Teacher Award

(For the most inspirational teacherin West Yorkshire. Nominations can only be submitted by those aged 16 and under. This award requires a video of no more than 3 minutes in length.)

Where do they teach?

What do they teach?

What age do they teach?

How do you know this person?

Please confirm that your nominee has agreed to be nominated.

If submitting a film (category 7) please confirm that you have the permission of everyone appearing in the film.

If children aged 16 and under are appearing in the film (category 7) please include the signatures of their parent/guardian.


If you are submitting a nomination for categories 1-6 please continue to complete Section A. If you are submitting a nomination for Category 7, please go to Section B

  1. In 250 words please tell us…

In what ways has this teacher inspired you? What impact has this teacher had on your life? Can you tell us about the qualities and character of this teacher? Has this teacher and their work had a wider effect on your family, friends or local community? Has this teacher gone the extra mile in their work?

*Now please go to the end of the next page to sign


  1. Please submit a film no longer than 3 minutes with this application. If sending by email please send a video data file (eg AVI, MPEG, MP4, MOV) via a file sharing website (such as Dropbox or WeTransfer) to . If posting the application form please send the film on a DVD or USB stick as a data file to Thank You Teacher, BBC Radio Leeds, 2 St Peters Square, Leeds, LS9 8AH.

Privacy Statement - Your personal information will be held by BBC Radio Leeds on behalf of the BBC and your details will only be used to process your application form for the Thank You Teacher Awards. It will be deleted six months on from the nomination end date. Your details will not be passed to any third party without your consent. Please visit the BBC's Privacy Cookies Policy ( for more information.

Terms and Conditions - For terms and conditions please see

I have understood the terms and conditions

Signed ……………………………………………………………………………….

Date…………………………………………………………………………………...

(If you or your nominee have not been contacted by 15 May 2015 this means that you have not been successful in these awards).

And finally - please ensure you fill in the details and sign the contributor consent form on the next page.

CONTRIBUTOR CONSENT FORM

Name of Production / BBC RADIO LEEDS THANK YOU TEACHER
Contributor/Nominator / Your name, address, tel & email
BBC Production Contact /
2 St Peters Square, Leeds, LS9 8AH
Contribution / Application form, film submission, interviews with nominators, nominees and winners.

Thank you for contributing to the Programme. By signing this form You agree to the following terms.

  • You agree to the recording and/or broadcasting of Your Contribution and assign to the BBC all rights in Your Contribution for the BBC to use it worldwide in perpetuity in all media known now or in the future.
  • To the best of Your knowledge and belief, Your Contribution will not infringe the copyright or any other rights of any third party or be defamatory.
  • The BBC may edit, copy, adapt or translate Your Contribution at the BBC’s discretion and You waive any “moral rights”[1] that may exist in Your Contribution.
  • The BBC will not be liable for any loss or damage to You or Your property unlesscaused directly by the BBC’s negligence.
  • Although the BBC hopes to use Your Contribution, it cannot guarantee to do so.
  • This Agreement is governed by the laws of England and Wales and the jurisdiction of the English and Welsh courts applies.

If you agree with these terms please sign below and return it to the BBC Production Contact. A copy is attached for you to keep.

If you are unsure of the meaning of any of the terms set out above, the production team can explain them to you.

Thank you once again for your assistance.

I agree to these terms:

Signed ………………………………………………….Date ………………………………………………….

1

[1]This means specifically the rights set out in sections 77 to 89 of The Copyright Designs and Patents Act 1988.