M-T1-CP-11-SD-01 — Award Nomination Form

Release control

Adaptation note

This derivative configures the canonical Local Hero Awards nomination form. It lets a person determine eligibility before providing personal information; aligns four evidence prompts to the published criteria; controls third-party nomination, nominee awareness, accessibility and safer contact; requests proportionate evidence only; separates nomination declarations from later recognition permissions; and routes every submission to a restricted register with a neutral receipt.

This is an operating and governance form, not legal advice or a certification of privacy, accessibility, safeguarding or award-law compliance. The accountable organisation must approve the local award charter, privacy position, collection notice, safeguarding route, records schedule, criteria, dates and system before release.

1. Instructions

1. Complete and approve the award charter, eligibility matrix, selection criteria, tie/no-award process, review boundaries and decision authority before opening the form.
2. Resolve every controlled field from approved records. Publish the current terms, eligibility, criteria, closing date, exact time and time zone beside the form.
3. Document why each personal-information field is necessary, who can access it and when it will be disposed of.
4. Test the actual digital and alternate-format pathways, acknowledgement, outage route and restricted intake register end to end.
5. Screen eligibility before merit scoring. Do not use this public form for detailed safety complaints, crisis reports or unnecessary sensitive information.
6. Ask for recognition/publicity permission only after selection; do not bundle blanket publicity consent into entry.
7. Keep the completed public form separate from the internal intake, eligibility, panel and incident records.

2. Controlled award and form fields

3. Local release gate

Release decision: Open / Hold Authorised by / date / evidence: ______________________________________________

4. Public form header

Award: ______________________________ Cycle and category: ______________________________ Nominations close: ______________________________, including time zone Form version: ______________________________

Why this award exists

________________________________________________________________________________ ________________________________________________________________________________

Before you begin

• Read the current eligibility rules: ______________________________
• Read the selection criteria and evidence guidance: ______________________________
• Allow approximately ______ minutes.
• Evidence prompt limits: ______________________________________________
• Accepted attachments: ______________________________________________
• For an accessible format, help or another safe way to nominate, contact: ______________________________
• Do not include identity documents, health records, allegations, private contact details about other people or information that is not necessary to assess this nomination.

5. Eligibility self-check

This check helps the nominator decide whether to continue. The program will complete a formal eligibility screen after submission.

If any answer is uncertain, use the clarification contact before submitting: ______________________________

6. Nominator details

Collect only the locally approved minimum.

Do not use these contact details for optional updates unless a separate, reviewed choice is offered.

7. Nominee details and awareness status

Nomination does not itself authorise public naming, photography, biography, media contact or sharing with partners.

8. Category and formal eligibility confirmations

The internal outcome columns must not be exposed in a public copy of the submitted form.

9. Nomination case

Write factually and attribute collective work fairly. State limitations. Do not include sensitive or private detail that is unnecessary.

A. Contribution in one sentence

Maximum ______ words.

________________________________________________________________________________ ________________________________________________________________________________

B. Community value and demonstrated outcomes

What changed for the relevant community, and how credibly is that change linked to the nominee? Describe relevance, depth and breadth, evidence, attribution, context and limitations. Maximum ______ words.

________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

C. Leadership, service and contribution

What distinctive, responsible and sustained contribution did the nominee make? Leadership may be formal or informal. Describe initiative, judgement, reliability, stewardship and service. Maximum ______ words.

________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

D. Inclusion, ethics and collaboration

How did the nominee listen, share ownership, reduce barriers, recognise partners and strengthen trust? Do not disclose personal characteristics merely to demonstrate inclusion. Maximum ______ words.

________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

E. Sustainability or ongoing value

What capability, benefit, relationship or learning is likely to endure or transfer? A responsible close may be appropriate for a time-limited response. Maximum ______ words.

________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

10. Evidence register

Evidence supports verification; volume is not a score. Do not upload restricted or unnecessary information.

11. Optional referee or verifier

Provide only if the approved category permits it.

12. Accessibility and safer contact

You may request an accessible format, communication adjustment or safer contact arrangement without giving a diagnosis or detailed personal history.

Requested adjustment or contact approach: ______________________________________________ Private route used, if needed: ______________________________________________

For a safeguarding, immediate-safety or sensitive concern, do not enter details in this general form. Use: ______________________________________________

13. Collection notice

Complete with locally reviewed wording before release:

[Host entity] collects the information you choose to provide to administer, assess, verify and communicate about [award and cycle]. We use restricted award-process roles and the approved decision authority. Some information may be shared with authorised verifiers or reviewers only where necessary and permitted. If required information is not supplied, we may be unable to assess the nomination. Read our privacy information at [route] or contact [privacy contact] about access, correction or a concern. The approved retention and disposal route is [plain-language summary].

14. Nominator declarations

Tick each declaration:

• [ ] I have read the current award terms, eligibility rules and criteria.
• [ ] To the best of my knowledge, the information is accurate and fairly attributes other people's work.
• [ ] I have not knowingly included unnecessary sensitive, defamatory, confidential or restricted information.
• [ ] I have authority or permission to supply attached evidence where required.
• [ ] I have accurately recorded nominee awareness or the approved third-party exception.
• [ ] I understand that submission does not guarantee eligibility, selection or public recognition.
• [ ] I understand that later recognition permissions will be requested separately if needed.
• [ ] I accept the locally approved declaration wording and collection notice version: __________

Nominator name / approved confirmation / date-time: ______________________________________________

15. Submit and neutral receipt

Submit button: Submit nomination

Receipt copy:

Thank you. Your nomination has been received under reference [reference] at [date-time and time zone]. Receipt does not confirm eligibility or selection. We will use the published process and contact route. If you need to correct an administrative detail or report a privacy, access or safeguarding concern, use [approved route].

Do not echo the completed nomination or private details in an ordinary email receipt.

16. Restricted internal intake record

17. End-to-end acceptance checklist

• [ ] A person can assess eligibility before providing personal information.
• [ ] Form, terms and criteria show the same program, cycle, category, version and closing time zone.
• [ ] Every collected field has an approved purpose, access role and retention rule.
• [ ] The four evidence prompts align exactly with the published criteria.
• [ ] Third-party, child-safe and at-risk-person routes are approved.
• [ ] Blanket recognition/publicity permission is not bundled into nomination.
• [ ] Keyboard, persistent labels, focus, error, contrast, zoom, screen-reader and alternate-format tests pass.
• [ ] Accepted file types, limits, malware controls and restricted access are tested.
• [ ] A test nomination reaches only the correct restricted register and creates one neutral receipt.
• [ ] Help, safer-contact, privacy and outage routes have active owners.
• [ ] Governance, privacy, safeguarding where applicable, accessibility, records and system reviewers have passed the release gate.
• [ ] Working copies, test submissions and exports are removed or retained under the approved route.

18. REVIEW approval

Until all applicable approvals and end-to-end tests pass, this derivative remains REVIEW.