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:
Young Person Award (aged up to 18 years old)
Service to Community Award – Individuals
Service to Community Award – Groups & Organisations
Service to Community Award – Businesses
Health and Wellbeing 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)
