Please note: this document is available in Welsh

Nominator’s Details

1. Please enter your contact details:

Full nameOrganisationAddress line 1Address line 2Town / CityCountyPostcodeEmail

Daytime phone numberMobile phone number

Nominee’s Details

2. Are you nominating (Please tick as appropriate):

An individual / family (go to question 3)

A project / organisation (go to question 6)

3. Please indicate your relationship to the person you are nominating (please tick all those that apply:

Carer Colleague

Employer Friend

Mentor Family

Student Tutor

Other, please specify

4. Please enter the contact details of the individual/family you are nominating.

Full name (this is the name that will appear on the certificate, please be clear) Organisation – ifapplicable CountyEmailDaytime phone numberMobile phone number

5. Please give the name of the learning provider or place of learning where the person / family you are nominating is learning:

6. Please enter the contact details for the project or organisation you are nominating.

Project / Organisation name (this is the name that will appear on the certificate, please be clear)Contact nameAddress line 1Address line 2Town/ CityCountyPostcodeEmail

Daytime phone

numberMobile number

Award CategoriesThere are 11 Inspire! Awards 2020 categories. For more information about each of the categories please read the Inspire Award Categories guidance.

7. Please indicate the category you would like the nominee to be considered for.

Individual & Family Awards Please tick one box only

Into Work Young Adult Life Change & Progression Health & Wellbeing Ageing WellStarting out – Welsh BeginnerDifferent Past: Shared Futures

Family LearningProject / Organisation Awards Please tick

one box onlyCommunity Project Skills at WorkClosing the Gap

Nominator statementPlease use this section to tell us why the individual, family, project or organisation you have nominated deserves this award. In writing your statements, please refer to the Inspire! Awards 2020 categories guidance and our guide on How to write a successful nomination, as judges will use these when making their decisions.

*If you would like to include additional supporting statements or images to your nomination, please attach them at the end of this form.

If you are nominating an individual or family, you may wish to include:

What is transformational about their learning journey and what has changed as a result

Describe how learning has had a positive impact on the individual or family’s life, and on those around them – how have they developed and used their skills - whether in their family, workplace or community.

Details of the learning completed, progress made and any personal and professional achievements

Tell us why your nominee deserves an Inspire! Award

If you are nominating a community project, you may wish to include:

Project objectives, details of the learning completed, progress made and any achievements

Any innovative approaches to learning What is transformational about the learning journey and what has

changed as a result Explain how learning has had a positive impact on those involved, in

the community or on those around them Outcomes of the project or activity

If you are nominating for a Skills at Work award you may wish to include:

The approach to workforce development – who is being targeted, how are they being reached.

The learning, skills, training and development opportunities available to employees and the progression of the learners involved.

The contribution the learning has made to the company, including to the working environment and to other colleagues (please provide any evidence).The partnership involved in delivering the learning activities.

If you are nominating for the Closing the Gap Award, you may wish to include:

Information about the partnership between the school and adult learning providers to develop and deliver learning opportunities for parents and the wider community

Evidence about the impact of the programme you have put in place – tell us about the impact on parents, children and the whole school environment.

The strategic approach to developing the school as a community hub – what have been the aims, how has it been achieved and why has it worked.

The ways in which new pathways have been created for the school and wider community to access learning opportunities.

8. Nominator’s statement (Please limit your statement to 500 words).

Nominee StatementThis is your opportunity to tell us about your learning experiences and how it has changed your life, tell us about any barriers you may have had to overcome to get where you are now. Information supplied will benefit your nomination. What messages do you have to inspire others to return to learning? Where do you think your journey will take you next?

9. Nominee’s statement (Please limit your statement to 500 words).

Private Information and Publicity If your nominee is selected as a winner, the information that has been provided in this form will aim to celebrate the success of your nominee and to inspire others to take up learning. We will request to use their story for our press or media activities. For example, we will want to include a profile of your nominee in a profile book and in a press release; take their photograph for publicity materials; film them for a video; or ask them to take part in an interview with the media. We will always ask your permission before featuring your nominee’s story in any of our press or media activities. Your nominee will also be asked to say a few words at the awards ceremony when presented with an award.

10. If there are details about your nominee’s story which you do not wish to be made public please let us know in the box below. Please also indicate if you or any of those involved in this nomination do not wish to have your photograph taken or be included in a video.

Press, PR and Marketing contact details Inspire! Award winners often generate local and national press or media interest. If your nominee is selected for an Inspire! award, Learning and Work Institute would like to liaise with that project’s or organisation’s Public Relations, Marketing Manager or appropriate persons to publicise winners.

11. Please enter the contact details of your organisation’s Public Relations or Marketing manager

Organisation Name

Contact Name Email address

Daytime phone number

Mobile phone number

Organisation’s Twitter handle

Organisation’s Facebook

Organisation’s Instagram Page

Nominator and Nominee declaration Please read the following statements carefully before signing the declarations. Only applications signed by both nominator and nominee will be accepted.

Nominator’s Declaration

By submitting this form and ticking the box, I confirm that:

I wish the named person, family, project or organisation to be nominated for an Inspire! Award 2020

The information supplied in this form is correct to the best of my knowledge and that the statement is true and accurate

I give my consent for Learning and Work Institute to use the information in this form

I understand that if the named person is selected as a winner, I / nominating organisation will be asked to take part in press and media activities

I have read this form and declaration carefully and fully understand its meaning

Nominee’s Declaration

By submitting this form and ticking the box, I / we confirm that:

I / We wish to be nominated for an Inspire! Award 2020 The information supplied in this form is correct to the best

of my / our knowledge and the statement is true and accurate

I / We understand that the information provided about me / us here will be passed onto third parties, including the press and media, for publicity purposes only (please note that we will not share your contact details with anyone without your prior consent)

I / We understand if I am / we are selected as a winner, I/we will be asked to take part in press or media activities, such as having my / our picture taken, taking part in a film and having my / our story included in a press release or inspire! Award promotional materials

I / We have read this form and declaration carefully and fully understand its meaning

12. We would like to keep you informed by email about further Learning and Work Institute events, activities, future award nominations and our campaigning work in Wales. If you are happy for us to contact you, please tick the box below.

Yes

If you would like to update your preferences, please contact:

enquries@learningandwork.org.uk -

Learning and Work Institute will only use personal data in accordance with the terms of consent given by the individual and/or (where applicable) the terms of the agreement under which they are supplied to L&W.

Data Protection Statement The Learning and Work Institute is registered under the Data Protection Act 1998 (Registered Number Z7412510). Personal information supplied to the Learning and Work Institute will be stored securely and may be used in relation to the Learning and Work Institute’s work.

Full details of the purposes for which the Learning and Work Institute processes personal information is in our Data Protection Register entry, which can be found on the Information Commissioner’s website www.ico.org.uk . At no time will we share personal information with other organisations without your express consent.

How can I submit my nomination form?BY EMAIL Please email your completed form to: inspire@learningandwork.org.uk

BY POST Please send your form to:Inspire! Nominations, Learning and Work Institute, 3rd Floor, 33 – 35 Cathedral Road, Cardiff, CF11 9HB

The closing date for entries is Friday 31 January 2020