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The Lord-Lieutenant's Award For Young People

Please note the closing date for nominations is 31st january 2010

Name of young person:

Date of birth (if known):

Age:

Address:

School/College/Organisation attended (if appropriate):

Award category:

Please select one of the following: -

Your name and address:

Your Email address:

Your telephone number:

Type of prize suggested up to the Value of £500:

Do we have parental consent for this nominee and permission to use their name and photograph in publicity material?

Please select one of the following: -

Yes

Please set out below your reasons for nominating the young person. Please try to provide as much information as possible as the judging panel can only make a decision based on the evidence provided.

Why are you nominating this young person?

What makes them stand out as being special?

What difference has their contribution made?

What time commitment do they give to this activity (not applicable to the bravery category)?

How is their achievement perceived by the community and their peers?

Is there any other information you wish to provide in support of your nomination? (You may send in other supporting materials)

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The Lord-Lieutenant's Award For Young People

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