Nomination Form (People's Honours) Step 1 of 4 25% The British Citizen Honours are selected to receive the recognition – Individuals do not ‘win’ a BCA but are presented with the honour. Only a limited number of British Citizen Honours medals are presented each year in each category. They are carefully considered by the BCA Independent Assessment Panel and each nomination is given a rigorous review before moving to the next stage. Further information or validation may be sought. Nominations not selected for a medal do not diminish the achievements of the candidate in any way, and should not be viewed as a negative response, it is simply the criteria which dictate the success of nominations and it is this process which makes the awarding of The British Citizen Honours so significant to those who receive it. Supply as much information as you can to validate your nomination – please also read Entry Regulations below I wish to nominate the following candidate and I am supported in this application by one other person (seconder). I confirm that I am not related to the candidate.How did you hear about The British Citizen Honours - The People's Honours Name of the person you are Nominating MissMrMrsMsProf.Dr.Rev. Title First Name Last Name Contact Address (Full) Address Line 1 Address Line 2 Town County Postal Code Date of Birth(Required) DD slash MM slash YYYY Home / Business phone Mobile phone(Required) Email(Required) Member of Parliament Constituency Name of MP Is the Nominee aware of this nomination – the completed nomination form will not be disclosed to the nomineePlease chooseYes, the Nominee is aware of being nominatedNo, the Nominee is not aware of being nominatedPlease note: Nominees will be informed in the event of deferral or request for further information by the assessment panel. Please select either The British Citizen Honours or The British Citizen Youth Honours (18 or under)(Required)Please chooseThe British Citizen Award (BCA)The British Citizen Youth Award (BCyA)Parent/Guardian Mobile Parent/Guardian Email Name of Parent/Guardian(Required) Please confirm Parent/Guardian approval(Required) Yes, approval is confirmed 1. Categories – choose category you recommend - If left blank, BCA will determine the most suitable category relating to the nominationPlease select which category you are nominatingPlease chooseBCAc for Service to CommunityBCAi for Service to IndustryBCAa for Service to ArtsBCAe for Services to EducationBCAh for services to HealthcareBCAb for Service to BusinessBCAv for Volunteering & Charitable GivingBCAo for International Achievement2. Please complete in the box below why you consider the Nominee should be considered for The British Citizen Honours (approx. 300 Words)3. What in your opinion makes this Nominee’s contribution exceptional? (approx. 300 Words)4. Has the Nominee’s contribution positively impacted a community, and if so, how? (approx. 300 Words)5. How long has the Nominee been engaged in the activity you have described in this submission and what has been the biggest impact? (approx. 300 Words)6. What other recognition (if any) has the nominee received for the activity described in this nomination (approx. 300 Words) -7. Is there any supporting evidence to validate your nomination?Please chooseYesNo*Supporting evidence could be, but not limited to, press cuttings, testimonials, personal references, web coverage, etc) Please attach copies or web links where appropriate, clearly marked with your candidates name on the tag line.Upload any evidence if available Drop files here or Select files Max. file size: 10 MB, Max. files: 10. Nominator details Nominator Name MissMrMrsMsProf.Dr.Rev. Title First Name Last Name Relationship to Nominee: Nominator MUST NOT be related to, or reside at the same address as, the nominee)(Required) Contact Address (Full) Address Line 1 Address Line 2 Town County Postal Code Phone number(Required) Email(Required) DECLARATION - See Nomination Regulations below before signing Declaration(nominations will not be accepted without signatures) I, the nominator, hereby confirm that the above information is accurate and true to the best of my knowledge and beliefSignature of Nominator(Required) Use your mouse (if on a computer) or your finger (if on a phone or tablet) to draw your signaturePrint full name of Nominator Nominator Undertaking(Required) By ticking this box you are giving an undertaking that the information provided in this nomination is true and accurate to the best of your knowledge. You are also giving an undertaking that the e-signature provided is a representation of your own signature and is to be treated as if you had signed the physical document.Entry Rules and Regulations(Required) By ticking this box you confirm that you have read the Entry Rules and Regulations that can be found HERE. Seconder Name MissMrMrsMsProf.Dr.Rev. Title First Name Last Name Date of Birth - Seconder(Required) DD slash MM slash YYYY Relationship to Nominee(Required) Contact Address (Full) Address Line 1 Address Line 2 Town County Postal Code Phone number(Required) Email(Required) Seconder Undertaking(Required) By ticking this box you are giving an undertaking that the Seconder has seen and approved the nomination and given you consent to provide their personal details on their behalf. An email will be forwarded to them when this nomination is submitted. © Awards Recognition Bureau