Application Form


    Part 1: Administrative Information.

    1. Are you nominating or applying?

    Applying for an award yourself or as part of a teamNominating someone else for an award

    2. Personal Details
    Please provide your personal details:


    Job title:

    Contact Address (Work):

    Contact Tel (Work):

    Contact Email (work):

    3. Please give details of the person OR team being nominated:

    Name/Team Name:

    Job title/Team Leader Name:

    Contact Address (Work):

    Contact Tel (Work):

    Contact Email (work):

    4. Are your nominees aware that they have been nominated by you to receive an award?

    5 Award Category
    Which award category is this application for?
    Clinical Team of the Year AwardNon-Clinical Team of the Year AwardRadio Wave's Unsung Hero AwardInnovation and Service Improvement AwardEmployee of the Year AwardVolunteer of the Year Award
    NB: The Blue Skies Award, Weightmans' Patients' Award and Chairman's Award are not open to nominations from staff.

    Part 2: Content

    1. Summary
    In no more than 100 words please provide a summary of how the nominee(s) are making a difference:

    2. Application
    In no more than 500 words please explain how the nominee(s) deserve to win an award.

    3. Prize Fund
    If you are nominating yourself or your team for an award category please explain in no more than 100 words how you would reinvest the prize fund if you/your team won the award.

    Before clicking the submit button, please ensure that you have completed all sections as appropriate. Applications cannot be amended once they have been submitted. Applications may be rejected if they do not meet the specified criteria (e.g. there are more than 500 words in the Application section).