Should You Wish to Make a Nomination Please Complete the Details Below

In Confidence

The principal objective of the Award Scheme is to give formal recognition to someone who has demonstrated significant involvement, contribution and dedication to the community either across or in part of the town of, Alnwick. The scope of the Award is a wide one, covering charity work, citizenship, caring and community participation and involvement. The nominee must be resident, work in Alnwick or undertake activities within the town.

Should you wish to make a nomination please complete the details below:

(Your nominee should not be informed of your submission)

Your name: ……………………………………………………………………………………………..………

Your address: …………………………………………………………………………………..……………….

…………………………………………………………………… Postcode: ………………………………...

Your Daytime Telephone Number: …………………………………………………………………...……...

I wish to nominate (insert name): ……………………………………………………………………………..

Their Address: ……………………………………………...…………………………………………………..

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…………………………………………………………………… Postcode: ………………………………...

Their Daytime Telephone Number: ………………………………..…………………....……………………

Continued overleaf

Please give details as to why you feel this nomination deserves recognition:

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……………………………………………..… (please continue on a separate sheet if necessary)

Up to three letters of support may be enclosed with your nomination. Please also give the names of any referees who may be able to supply further information about the nominee (including a telephone number).

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

Are you happy for the person you nominate to know you nominated them Yes No 

The judging of these Awards will be undertaken by a panel of judges at the end of April and the presentation of Awards will be made by the Mayor of Alnwick at an Awards Ceremony on May 4th.

Thank you for taking the time to complete this form. You may be contacted for further information regarding your nomination. You will receive an acknowledgement of your nomination but it is not possible for us to enter into correspondence on the individual merits of any particular nomination.

Closing date for nominations is 25th April 2016.

Once complete please return this form to:

Janet Pibworth

Assistant to the Town Clerk

Alnwick Town Council

Room 5, 27 Fenkle Street

Fenkle Street

Alnwick

Northumberland NE66 1HWE-mail: