Inspire! Nomination form 2016

The closing date for entries:

4th March 2016

Nominator’s Details

1. Please enter your contact details:

Full name
Organisation
Address line 1
Address line 2
Town/ City
County
Postcode
Email
Daytime phone number
Mobile phone number

Nominee’s Details
2. Are you nominating:


An individual (go to question 3)

A project (go to question 9)
An organisation (go to question 9)

3.Please indicate your relationship to the nominee:
Carer Colleague

Employer Friend

MentorParent

Student Tutor


Other, please specify

4. Please enter the nominee’s contact details.

Full name
Organisation
Address line 1
Address line 2
Town/ City
County
Postcode
Email
Daytime phone number
Mobile phone number

5. Please give the name of the nominee’s learning provider or place of learning:

6. Please describe the nominee’s gender identity.

Female (including male-to-female trans women) X

Male (including female-to-male trans men)Other

Prefer not to say

7. Please give the nominee’s age
16 – 24 50 – 54

25 – 29 55 – 59

30 – 34 60 – 64

35 – 39 65 – 69

40 – 4470 – 74

45 – 49 75+

Prefer not to say

8. Please describe the nominee’s employment status (please tick those that apply)

Full-Time Employed Retired

Part-Time Employed Full-Time Student

Self-Employed Part-Time Student

Unemployed Carer

Not seeking work Volunteer

8.1 Please give the nominee’s job title if knownJob title (if known)

9. Are you nominating your own organisation or project?
YesNo

10. Please enter the contact details for the organisation/project you are nominating.

Organisation/ Project name
Address line 1
Address line 2
Town/ City
County
Postcode
Email
Daytime phone number
Mobile number

Award Categories

There are nine Inspire! Awards 2016 categories. For more information about each of the categories please read theInspire! Award Categories guidance.

11. Please indicate the category you would like the nominee to be considered for.

Individual Awards / Please tick one box only
Into Work
Family Learning
Young Adult
Life or Career Change
Progression
Health & Wellbeing
Employer or Project Awards
Employer of the Year – Small
Employer of the Year – Large
Community Project of the Year

Nominator’s Statement
Please use this section to tell us why the person or organisation you have nominated deserves this award. In writing your statements, please refer to theInspire! Awards 2016 categories guidance, as judges will use these when making their decisions.

If you are nominating an individual, you may wish to include:

  • Comments or a brief statement from the nominee themselves
  • What is transformational about the learning journey and what has changed as a result
  • Explain how learning had has a positive impact on the individual, employee or participants’ life, on those around them – whether in their family, workplace or community.
  • Details of the learning completed, progress made and any achievements

If you are nominating an employer or project, you may wish to include:

  • Project objectives, details of the learning completed, progress made and any achievements
  • Any innovative approaches to learning
  • What is transformational about the learning journey and what has changed as a result
  • Explain how learning has had a positive impact on the individual, employee or participants’ life, on those around them – whether in their workplace or community
  • Outcomes of the project or activity and impact on individuals, businesses or community

12. Nominator’s statement (Please limit your statement to 500 words).

Private Information

As we use the information that has been supplied in this form to inspire others to take up learning we want you and those involved in this nomination to be completely happy with what has been written.

We may request to use your nominee’s story in our press or media activities. For example, we may want to include a profile of your nominee in press releases; take their photograph for publicity materials; film them for a video; or ask them to take part in an interview with the media. We will always ask permission before featuring your nominee’s story in any of our press or media activities.

Award winners will be invited to attend the Inspire! Award Ceremony, where they may be invited to speak briefly about their experiences.

13. If there are details about your nominee’s story which you do not wish to be made public please let us know in the box below. Please also indicate if you or any of those involved in this nomination do not wish to have your photograph taken or be included in a video.

Information Press, PR and Marketing contact details

Inspire! Award Winners often generate local and national press or media interest. If your nominated individual, employer or project is selected for an award, Learning and Work Institute would like to liaise with your organisation’s Public Relations or Marketing Manager to publicise winners.
14. Please enter the contact details of your organisation’s Public Relations or Marketing manager (if applicable).

Full name
Email address
Daytime phone number
Mobile phone number

Nominee’s and Nominator’s declaration

Please read the following statements carefully before signing the declarations. Only applications signed by both nominator and nominee will be accepted.

Nominator’s Declaration

By submitting this form and ticking the box, I confirm that:

  • I wish the named nomine to be nominated for an Inspire! Award 2016
  • The information supplied in this form is correct to the best of my knowledge and that the statement is true and accurate
  • I give my consent for Learning and Work Institute to use the information in this form

I confirm that the above declaration is true

Nominee’s Declaration

By submitting this form and ticking the box, I confirm that:

  • I wish to be nominated for an Inspire! Award 2016
  • The information supplied in this form is correct to the best of my knowledge and the statement is true and accurate
  • I agree that my name and information provided about me here can be passed onto third parties including the press and media for publicity purposes only (please note that we will not share your contact details with anyone without your prior consent)

I confirm that the above declaration is true

15. Would you like to be kept informed about Learning and Work Institute activities, including events in your area?

Yes No

Data Protection Statement

The Learning and Work Institute is registered under the Data Protection Act 1998 (Registered Number Z7412510). Personal information supplied to the Learning and Work Institute will be stored securely and may be used in relation to the Learning and Work Institute’s work.

Full details of the purposes for which the Learning and Work Institute processes personal information is in our Data Protection Register entry, which can be found on the Information Commissioner’s website At no time will we share personal information with other organisations without your express consent.

The closing date for entries is Friday 4th March, 2016