Golden Hearts Awards 2023 Nomination Form

Step 1 of 2

Unique ID

Do you work at Hull University Teaching Hospitals NHS Trust?(Required)

This can be as an employee, contractor or student.

Yes

This form does not save your nomination until you submit it at the end. We strongly recommend first typing your nomination into Microsoft Word, so you have a copy of it to paste into this form, rather than typing it directly into the form for the first time. We cannot be held responsible for technical issues with the internet or network which cause you to lose your submission, so it's safer for you to write it on your computer first.(Required)

Yes, I understand - take me to the form!

We would love to hear from you! Please visit our Moments of Magic nomination page, where you can tell us about the member of staff or team who deserves a big thank you.

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 Hearts 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 title?(Required)

What department do they work in?(Required)

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

Which site do they work at?(Required)

Please specify which site.(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)

Your Department(Required)

Your Health Group / Directorate(Required)

Your Site(Required)

Please specify which site.(Required)

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