Nominate Someone for a 2018 Diana Award in Northern Ireland and Wales. Deadline 26th April 2018 at 23:59
The Diana Award is given out in Diana, Princess of Wales’ name to young role models, aged 9-18 from across the world who are selflessly transforming the lives of others. We are looking to recognise young people going above and beyond in their daily lives to create and sustain positive change.
Nominator Information

First Name *

Last Name

What is your job title?

What is your professional relationship to nominee?

PLEASE NOTE: Nominations can only be made by adults who know the nominee(s) in a professional capacity e.g. teachers and youth workers. Nominations made by family members or friends with no form of professional relationship with the nominee will be invalid.
What is the best phone number to contact you on {{answer_fsuM}}?

Nominee Information

Are you nominating a group or individual? *

If you are nominating a group, please complete our Group Nominee form which can be downloaded here:

Please ensure ALL FIELDS within this form are completed or your nomination will be invalid.

Once completed please save and upload *

What is the first name of the young person you are nominating? *

Surname? *

What is their date of birth? *

What is {{answer_ddmk}}'s age at time of nomination *

Please note: nominees for The Diana Award and Legacy Award must be between the ages of 9 and 18 inclusive.
Nominee Gender *

What is {{answer_ddmk}}'s home town?

If successful your young person would be invited to a celebration event local to them
And their UK region or country? (e.g. East Midlands if in the UK or country name if outside of the UK)

Does {{answer_ddmk}} fall under any of the categories below?

Please note these questions are entirely optional and all answers will be treated in the strictest confidence

Please choose one option that best describes your nominee's ethnic group or background. If you do not wish to disclose this there is an option at the bottom of the list.

How long has {{answer_ddmk}} been carrying out the activities you are nominating them for? *

Please note this must be for at least 12 months which you must evidence when answering the category criteria questions.
Organisation Details

Please provide your organisation information that is most closely associated with your nominee. Note that if your nomination is successful this is the organisation that will be displayed on the Diana Award certificate.
Organisation Name *

What is {{answer_NUZF}}'s Address *

And the country or UK region? (Please note nominations are now closed for 2018, however we have extended the nomination period for Northern Ireland and Wales until 26/04/18) *

Nomination Form

REMINDER: Please include as much information as possible and refer to the Nomination Guidelines when completing the next sections to ensure you are providing the most appropriate information. Please also remember that it's best to complete this information in Word or a similar programme and then copying it into the form should you be unable to complete them all in one sitting.
Opening Statement *

Please provide a statement of no more than 100 words encompassing why you are nominating your nominee(s) and the difference that their work has had on the lives of others or to a certain cause (note: if your nomination is successful this statement will be used for press and publicity so make this shine!)
Criterion 1: Vision

Demonstrates commitment and passion to the cause, evidenced through their service to that cause and through social action *

_Guidance Questions
- What selfless activities has your nominee(s) undertaken and for what cause(s)?
- Why did your nominee(s) decide to get involved in their chosen cause(s)?
- What sparked their interest to get involved in the first place?
- Why are they passionate about the cause?
Criterion 2: Social Impact

Creates positive social change that is of benefit to the wider community *

_Guidance Questions
Describe the impact your nominee(s’) activities have had on the lives of others.

Examples of impact for different types of social action could include:

- Fundraising: total amounts of funds raised for a cause and what the funds will be used for.
- Volunteering: relieving teacher’s time in class through classroom assistance or providing assistance in a charity shop.
- Anti-Bullying: statistics related to a fall in bullying, statements from school pupils who say they feel safer in school or the number of school pupils worked with to raise awareness of bullying.
- Campaigning: numbers of people reached through the campaign and numbers of people who have taken action as a result of the campaign.
- Care work: improvements in quality of life for those that have been cared for.

Criterion 3: Inspiring Others

Through their positive attitude and passionate approach to life they are a role model to others *

_Guidance Questions
Describe how your nominee(s) act as a role model to others including their peers.

Provide examples such as leading school assemblies, taking positions of leadership or responsibility, or situations where they have been looked up to by others.
Criterion 4: Youth Led 

Demonstrates how the young person(s) have led, owned and shaped the activities you are nominating them for *

_Guidance Questions
*How has the nominee(s) taken ownership of their activities? Did they initiate their chosen activities on their own accord?
If not or if they are part of an existing initiative such as a peer mentoring or anti-bullying ambassador scheme; how have they gone over and above what would be expected of them or how have they shown ownership of their role?

*How have your nominee(s) engaged with their networks to ensure the success of their chosen activities?

* How have they worked with their school, youth group, teachers, businesses or any other person or group that may have been able to support their activities?

Describe any challenges the nominee(s) faced and how they overcame them.

Detail the personal challenges that the nominee has faced and overcome as well as the skills and personal qualities they developed to achieve success.
Criterion 5: Service Journey

Evidence of transformation throughout the nominee(s’) service journey, including attitude, skills gained and challenges overcome *

_Guidance Questions
What has been the benefit to the nominee(s) as a direct result of taking part in the activity you are nominating them for? _

Include any skills gained such as teamwork from working as part of a group or empathy gained from peer mentoring as well as any improvement in future prospects such as relevant career experience or relationships developed with businesses and other organisations._
Beneficiary Testimonial

Please provide us with the details and testimony from someone who has directly benefited from the activities or service of the nominee/s. This could be an adult or young person and the testimonial should be no more than 200 words. Please ensure you obtain permission from the beneficiary prior to submission. If it is not appropriate to give their name, please detail their relationship to the nominee.
Beneficiary First Name

Beneficiary Last Name

Organisation *

Phone Number

Relationship to nominee? (e.g. friend, service user, teacher etc) *

Please note beneficiary providers should have a professional relationship with the nominee unless the nominee is a carer for the beneficiary provider.
Testimonial *

Please provide a written statement from someone who has benefited from your nominee's activities.

Note If you would prefer to provide this statement as a word document or as a pdf please continue to the next question.

If you have not filled out the testimonial in the previous question. Please upload your beneficiary testimonial as a word document or pdf here. This should be no longer than 200 words.
Referee Information

Please provide contact details for another adult who knows your nominee in a professional capacity.Please ensure you obtain permission from the referee prior to submission. If it is not appropriate to give their name, please detail their relationship to the nominee.
Referee First Name

Referee Last Name

Organisation *

What is the Reference Providers professional relationship with the young person *

PLEASE NOTE: Reference providers can only be adults who know the nominee(s) in a professional capacity e.g. teachers and youth workers. Reference providers who are family members or friends with no form of professional relationship with the nominee will be invalid.
Phone Number

Additional Information for '2019 Legacy Award'

In 2019 The Diana Award will present the Legacy Award to 20 outstanding young people, selected from successful individual Diana Award nominations from academic years 2017 - 2018 and 2018 - 2019. Please see nomination guide for timeline. Please note unfortunately groups are not eligible for the Legacy Award, however if you feel there is an individual in your group who shines out please do nominate them separately for The Diana Award/Legacy Award. An international Judging Panel will have the difficult task of selecting the top 20, they are looking for visionaries, leaders and role models, able to inspire and mobilise new generations to serve their communities. Please use this section to provide the judges with any additional information you feel would add value to the evidence you have already provided against the criteria.
If you have completed the Legacy Award section please indicate if your nominee is already a recipient of The Diana Award

Please confirm you are happy for The Diana Award to contact you regarding this nomination

Thanks {{answer_fsuM}} your nomination form is now complete!

Please note that the information contained in this nomination is strictly confidential and will not be communicated to any person other than those involved in the assessment of the Award.

By submitting this nomination you declare that the information you have provided is – to the best of your knowledge – accurate and complete. Providing false information may lead to your nominee being removed from the process at any stage. We recommend you review your nomination before submitting. If you are satisfied with your answers just hit submit below.
Thank you for your nomination.