Golden Stars Awards Nomination Form

Golden Stars Awards 2024 Nomination Form

Unique ID

I am making this nomination as a...(Required)

Staff member

Patient

Relative, friend or carer

Member of the public

This form won't save your work until you hit submit at the very end. To be safe, it's best to write your nomination somewhere else first, like your phone's notes app or a computer program like Microsoft Word. Then, once it's written, you can just copy and paste it here. That way, if the internet goes down or something happens, you won't lose all your hard work!(Required)

Yes, I understand this advice.

The Nomination

Please choose an award category(Required)

View a full list of all categories and criteria

Please tell us, in as much detail as possible, why this individual or group of people deserves a Golden Stars Award. Please use examples and supply evidence where possible.*(Required)

For more information about how to write your nomination, please see the FAQs and Guidelines.

Supporting Evidence

Please upload here if you have any additional evidence to support your nomination, such as documents or photographs.

Drop files here or

Max. file size: 500 MB.

About the Nominee

How many people are included in this nomination?(Required)

If you're not sure of exact numbers, please give a rough estimate.

Please enter a number greater than or equal to 1.

What is their name?(Required)

Forename Surname

What is the name of this group of people?(Required)

E.g. the name of the ward, department, committee, network, project group, etc.

Please name as many of the people involved as possible. If you can, please include full names.(Required)

Who is the leader of this group of people?(Required)

Forename Surname

E.g. for a ward nomination this would be the charge nurse. For a committee, network or project group, this would be the chair or project lead.

What is their contact number?(Required)

What is their email address?(Required)

What is their job role?(Required)

Which department do they work in?(Required)

What care group or directorate do they work in?(Required)

Please specify which care group or directorate they work in.(Required)

We will review the list of care groups and directorates on a regular basis as NHS Humber Health Partnership develops.

Which site do they work at?(Required)

Please specify which site they work at.(Required)

Are they aware of your nomination yet?(Required)

Yes

Now a bit about you

Your Name(Required)

Forename Surname

Your Email Address(Required)

Your Contact Number(Required)

Your Job Title(Required)

Which department do you work in?(Required)

What care group or directorate do you work in?(Required)

Please specify which care group or directorate you work in.(Required)

We will review the list of care groups and directorates on a regular basis as NHS Humber Health Partnership develops.

Which site do you work at?(Required)

Please specify which site you work at.(Required)

Phone

This field is for validation purposes and should be left unchanged.