OXFORDSHIRE SPORTS AWARDS NOMINATION FORM 2017
DISABILITY SPORTS AWARD
Nominee Information: (Person/Club/Team being nominated)
Name of person/club/team: / Age (if applicable): / Sport:“This award recognises an individual, club or team’s key achievements over the last year, evidence of dedication and the barrier’s that have been overcome from participation to performance”
Criteria:
1. Key achievements since 1st November 2016
2. Dedication to training
3. What makes them a role model/inspiration and to who? (Include barriers that have been overcome from participation to performance)
4. What do they aspire to do next? How do they plan to achieve it?
Please use the spaces below to explain how the nominee meets the category criteria. You must
· ensure that you provide all of the requested information outlined in the category criteria
· use no more than 150 words for each criteria
Failure to do the above will result in your application not being considered for shortlisting. Please refer to the guidance notes for more information.
Criteria 1:
Criteria 2:
Criteria 3:
Criteria 4:
CONTACT DETAILS
Nominee: (Individual, club or team being nominated)
Address: / Postcode:Date of Birth:
District: (please select)
Cherwell Oxford City South Oxfordshire Vale of White Horse West Oxfordshire
Telephone (daytime): / Mobile: / Email:
Nominator:
Name: / Date of Birth:Address: / Postcode:
Telephone (daytime): / Mobile:
Email: / Relationship to nominee:
Where did you hear about the Oxfordshire Sports Awards?
Declaration: I confirm to the best of my knowledge the details given are correct
Signed: / Date:
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