Community Wellbeing Champion Awards 2025 Nomination Form

Please Complete this form to nominate an individual or group for the Community Wellbeing Awards. Ensure the nominee lives or is based in Hartlepool and does not receive payment for the work for which they are being nominated.

1. Your Contact details (contact details of the person making the nomination) *

Full Name:	*
Address	*
Phone number	*
Email Address:	*

2. Contact details of the person you are nominating: *

Full Name or Group Name:	*
Address:	*
Phone Number:	*
Email Address:	*
Confirmation that the nominee is happy to be nominated (Yes/No)	*

3. Award Category: Please select one of the following categories: *

Young Champion (aged up to 18 years)
Adult Champion (aged over 18 years)
Group Champion ( voluntary community)
Dementia Champion (dementia related care or support)

4. Why are you nominating this person or group?

Please tell us what they have done to make a difference in their community? *

5. Are there any other details or background you feel should be considered? no more than 250 words *

The closing date for nominations is 5pm on Friday, 29th August

Awards to be presented at the annual World Mental Health Day Celebration at