Ben Kinsella Award 2022

About you

1. Name
2. Address
3. Postcode
4. Phone number
5. Mobile number
6. Email
7. What connection do you have with this young person?
8. Would you be prepared to say a few words in support of your nomination at the awards ceremony? Select... Yes No

9. The closing date for all nomination forms is Friday 21 January 2022

Nominee details

1. Name of nominee
2. Date of birth (DD MM YY)
3. Address
4. Email address
5. Postcode
6. Phone number
7. Please tell us why you wish to nominate this young person
8. Do they do this activity as part of an organisation/charity? Select... Yes No
9. When did they begin this work?

10. All nominations for awards are treated in the strictest confidence. The nominee should not be informed that they have been nominated, as it is not fair to raise expectations in case they are not met. If they are nominated, we will ask you for their contact details which you should discuss with them first.

11. Please note that we may need to contact you regarding your nomination

    Please tick this box to confirm that you have read the above.

1. Interested in how we use your data? Read our fair processing notice.