Babergh & Mid Suffolk
District Councils
Community
Achievement
Awards
Nomination Form
In Partnership with
and generously
sponsored by
Nomination Form
Please select one category to enter:
Please tick box below
Category 1
Rising Star
This nomination would recognise a young person or group of young people (under 18 years) who
have made an outstanding contribution to their local school or community – for example:
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Undertaking voluntary work/involvement with local voluntary organisations
Supporting/mentoring others
Care and dedication shown to another individual
Fundraising for local projects
Category 2
Community Hero
This nomination would recognise a person who has provided selfless service to a voluntary body
or made a significant contribution to their community, making a real difference to the people and
place that they have supported – for example:
• Dedication to helping/supporting members of the local community
• Working for the benefit of the local community by contributing to the improvement of its local
facilities
• Fundraising for local projects
• Voluntary work/involvement with local voluntary organisations
• Work in relation to improving the environment
Category 3
Action in the Community
This nomination would recognise the work of groups of people (two or more) in the district whose
actions affect the wider community either by improving the environment or by providing help to
those in need – for example:
• Working together on a project(s) to support and benefit the local community
• Fundraising activities
• Work in relation to improving the environment
Category 4
Outstanding Local Business
This nomination would recognise a business located within Babergh or Mid Suffolk (with the
exception of our sponsors) which has made a significant contribution to either the social or
environmental well-being of the district and its residents – for example:
• Any business that benefits the community/district by contributing to the improvement of
facilities and services, and works towards reducing the barriers between the business sector,
the voluntary sector and the local community
Please print all the application form in BLOCK CAPITALS
Person, Group or Business being nominated:
NAME of PERSON(s): .............................................................................................................................................
GROUP or BUSINESS: ............................................................................................................................................
ADDRESS of person(s), group or business:
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Tel. No: ........................................................................................................................................................................
Mobile No: ..................................................................................................................................................................
Email Address: .........................................................................................................................................................
AGE of person(s) or group you are nominating if under 18:
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Is the person(s) or group paid for undertaking the work? YES/NO (delete as appropriate)
Person making the nomination:
NAME: ........................................................................................................................................................................
ADDRESS: .................................................................................................................................................................
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Tel. No: ........................................................................................................................................................................
Mobile No: ..................................................................................................................................................................
Email Address: .........................................................................................................................................................
Signature: ..................................................................................................................................................................
Date: ...........................................................................................................................................................................
Please use this section to indicate the general nature of the contribution/service given
and the period during which that work has been carried out. Give as much information as
possible in order to help the judging panel. A continuation sheet may be attached to this
nomination form together with detailed background information, letters of support etc.
PLEASE REMEMBER NOMINATIONS MAY BE DISCOUNTED IF THERE IS
INSUFFICIENT INFORMATION
Describe the contribution / service given by the individual / group / business: ........................................
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Continue on a separate sheet if necessary
Indicate timescale this contribution covers: ......................................................................................................
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If the nomination relates to fundraising, indicate the level of funding and how this has been
achieved: ...................................................................................................................................................................
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If appropriate, detail the number / range of people or groups who have benefitted from this work:
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Please tell us if you have provided statements / letters of support for this nomination:
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In which Parish/Town and District is the person(s), group or business undertaking this work?
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Has this person(s), group or business been rewarded in any other way for their work?
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Please send the completed nomination form to:Babergh & Mid Suffolk District Council
Communities Team
131 High Street, Needham Market, Suffolk, IP6 8DL
by 12 noon on 31st December 2015
Please mark the envelope
“CAA Nomination”
For Office Use Only:
Nomination verified by:
Date:
In Partnership with
and generously
sponsored by