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Your Details

First name*

Last name*

email address

If you do not have an email address, please provide a full postal address below:

House name/number





Are you *

About your nominee

If you wish to nominate a team, please provide us with a contact name for the team by completing the below:

First name *

Last name*

Team name if applicable

Site where they work*

Star Award nominations should incorporate the trust's values which are:

Caring about what we do

Listening in order to improve

Respecting and valuing each other

Always doing what we can to be helpful

Patients at the centre of everything we do

Your nomination

Please use the space below to tell us why you wish to nominate the above person/team. Please give as much detail as possible*

How we will use your nomination

The Trust uses nominations in a number of ways in order to represent the services we deliver, including printed information, displays, exhibitions, on our website and on social media. Occasionally we may contact you with opportunities to submit your nomination for other award schemes.

By submitting this form you agree that your nomination can be used for these purposes by the Trust. We reserve the right to continue to use the nomination until you advise otherwise.

I give my consent as indicates above*

I would like my nomination anonymised for all publication and media use

Thank you for taking the time to complete the above Star Award nomination, please now click on the submit button to complete your nomination.

Email 2*:

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Do you know someone who has been a real star, someone who has gone above and beyond the call of duty?

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