Stockton-on-Tees Borough Council
2019-20 Mayor’s Civic Awards Nomination Form
This form is to be used for nominations for the Mayor’s Civic Awards. Those submitting the
nomination should explain why the person / group/ organisation / business nominated should
receive the Award and describe the contribution the nominee has made to the life of the
Borough overall, or to their local community.
A panel chaired by the Mayor including representatives from our communities will assess each
nomination on its merits using the evidence provided on this form. Therefore please make sure
that you provide all the relevant details, along with your contact information in case of queries.
The successful candidates will be invited to the Council’s Annual Meeting to be presented with
their Awards.
Please tick () the box next to the category that this nomination applies to:
1
Young Person Award (aged up to 18 years old)
2
Service to Community Award Individuals
3
Service to Community Award Groups & Organisations
4
Service to Community Award Businesses
5
Health and Wellbeing Award
6
Green Award
7
Carer/Foster Carer Award
Name and address of person/ group/ organisation / business being nominated:
Name:
Address:
(Must be completed)
Contact details of person submitting the nomination, so that we can contact you if we
need more information:
Name:
Address:
Telephone number: E-mail address:
(Must be completed)
Please supply the name and address of any additional supporters
(Optional)
Signed……………………………………………….
Date………………………………………………….
Please return the completed form to Margaret Waggott, Head of Democratic Services, Municipal
Buildings, Church Road, Stockton-on-Tees TS18 1LD or email to
mayors.office@stockton.gov.uk or fax 01642 528162.
Closing date is Friday 24 January 2020.
Thank you.
In this section please provide reasons why you feel the person / group/ organisation /
business deserves the Award. (Please use additional pages if necessary but limit to no
more than 400 words).
Please continue on a separate sheet if necessary
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