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European Economic and Social Committee

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AWARD nomination FORM

(Please refer to the announcement and eligibility criteria on our website)

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Please send your nomination (this application form filled in and supporting information, if available) by email to OR by post to the EESC, "Relations with civil society organisations and constitutional affairs" Unit, Rue Belliard/Belliardstraat 99, 1040 Bruxelles/Brussel, Belgique/België by 7 October 2011 (date of post).

ORGANISATION NOMINATING THE CANDIDATE*

Select the appropriate box / Member of the EESC
National ESC or Similar Institution
European civil society organisation or network
Name of the organisation
Country
ADDRESS:
Street / Post Box
Postal Code, City
CONTACT PERSON:
Name (Ms, Mr)
Phone number
Fax
Email
Website

*If the candidate is nominated by a member of the EESC, please fill in only the section "Contact person”.

THE CANDIDATE

Name of the organisation
Country
FULL ADDRESS:
Street/Post Box
Postal Code, City
CONTACT PERSON:
Name (Ms, Mr)
Telephone
Fax
Email
Website
Organisation's aim and main activities (no more than 500 words)
Please fill in as appropriate
Entry criteria /  The candidate is a civil society organisation, established within the EU.
 The initiatives/projects that have led to the organisation being proposed for the prize address the theme of 2011 Civil Society Prize:
Dialogue and participation fostering EU values: Integration, diversity, solidarity, tolerance
Title of the project or initiative
Period covered by the project(s)/initiative(s) / From: ______To: ______

OVERVIEW OF INITIATIVE(S)

Please explain in no more than 300 words how the initiative(s)/project(s) proposed for the prize comply with the eligibility criteria for the 2011 Civil Society Prize (please refer to the eligibility criteria on the EESC website)
Using a maximum of 1000 words, please provide an overview of the initiative(s)/project(s), which should include: the nature of the initiative, its objectives, content, impact, geographical scope and the time period it covers.
Please state, in no more than 300 words, how the initiative(s)/project(s) proposed for the prize can be said to exemplify best practice for civil society initiatives.

SUPPORTING INFORMATION

Applicants are invited to provide additional supporting information as available, and encouraged to send documents in electronic version whenever possible. Supporting information may include:
-publications (leaflets, brochures etc. promoting the initiative/project)
-links to websites related to the initiative/project (to be mentioned in the application form)
-media coverage (if any)
-any other material and proof of the impact of the initiative/project justifying the organisation being proposed for the civil society prize
This information can be provided in two ways:
-BY POST, together with the completed nomination form to: European Economic and Social Committee, "Relations with civil society organisations and constitutional affairs" Unit, RueBelliard/Belliardstraat 99, 1040 Bruxelles/Brussel, Belgique/België, by 7October 2011 (date of post)
OR
-BY EMAIL to , in electronic format together with the completed nomination form, by midnight on 7 October 2011.

LIST OF SUPPORTING DOCUMENTS

Please list below the supporting documents attached to this nomination.
1. ______
2. ______
3. ______
4. ______
5. ______

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