Outstanding Volunteer Nomination Form

AVA Awards: Outstanding Volunteer

Name of nominee:*
Address of nominee:*
Telephone number of nominee:*
Email address of nominee:
Name of nominator:*
Address of nominator:*
Telephone number of nominator:*
Email address of nominator:
What is the role and remit of the organisation(s) where the volunteer contributes? Please provide as much information as possible:*
How does he/she contribute to the organisation? Please give details of their role, length of time with the organisation and specific contribution:*
How has their contribution made a difference to the organisation, its beneficiaries and/or the wider community? (at least 1 specific example):*
Please give details of any challenges overcome and/or notable successes the nominee has encountered? Please give examples where possible:*
In your opinion, why should the nominee(s) be recognised for their outstanding contribution as a volunteer?:*
In what capacity do you know the nominee (eg volunteer, staff member, service user) :*
Date of Nomination::
Please give the name and contact details of a referee who can be approached to verify the above information:*

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