NOMINATION OF ANOTHER INDIVIDUAL, ORGANISATION, GROUP, CLUB OR PROJECT

Please use this form to nominate any individual, organisation, group, club or project you know of that is helping people in Wiltshire to live healthier lives. Please do not use this form to nominate work in which you are significantly involved. If you want to nominate work in which you, your organisation, group, club or project is involved, please complete the nomination form for the relevant award/s category from the Wiltshire Council website at

How to nominate another individual, organisation, group, club or project

  • Answer all the questions in full
  • If you want to nominate more than oneindividual, organisation, group, club or project, please submit separate forms for each one
  • Email the completed form to:

or post it to: Public Health Awards, Public Health, First Floor, Wiltshire Council, County Hall, Trowbridge, Wiltshire BA14 8JN

  • The closing date for your nomination isMonday 18th April 2016
  • We will contact the nominee soon after we receive your nomination and ask them to tell us more about their work so we can put it forward for judging.

Name of the individual, organisation, group, club or project whose work you arenominating:

Contact details of a person at the nominated project/group/club/organisation:

Name: / Address:
Email:
Tel:

Which award category or categories are you nominating this work for?

If you’d like more information about the categories, have a look at the website at

Award categories(delete YES/NO as appropriate)

Tackling health inequalities in the community awardYES/NO

Tackling obesity awardYES/NO

Pasante improved sexual health and/or reduced teenage pregnancies awardYES/NO

Innovation in public health awardYES/NO

Improvement in mental health and wellbeing awardYES/NO

Promoting safety and reducing harm awardYES/NO

Workplace health and wellbeing awardYES/NO

Primary care contribution to public healthYES/NO

To nominate for the Outstanding contribution award, please use the relevant form from the website at

Why are you nominating this individual, organisation, group, club or project?

Explain what it is that makes themstand out as special? (Max 100 words)

Please give us yourown contact details here, so we can get back to you if we have any questions:

Name: / Address:
Organisation: (if any)
Email:
Tel: