Healthwatch STAR Awards Nomination Form

Do you know someone who has gone the extra mile to make a difference for others in South Tees?

People often tell us about their positive experiences of services and groups on offer in the local area, and the difference these have made to their wellbeing.

We believe those who make a positive difference should be recognised and so the Healthwatch South Tees Award of Recognition celebrates those who make a difference to the people they support and their communities as well as going that extra mile to help others.

Please note that Monday 2nd March, 2020 is the closing date for nominations.

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* 1. Please provide us with your contact details:

Name:

City/Town:

E-mail address:

Phone number:

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* 2. What is the name of your nominated STAR?

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* 3. Where does your STAR work or help people?

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* 4. Which of these best describes your STAR? (please tick those that apply)

Professional

Volunteer

Member of the public

Individual

Group / team

Please tell us why your STAR deserves this Award of Recognition:

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* 5. How have they gone above and beyond what is expected of them?

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* 6. How have they helped to make a difference?

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* 7. What difference have they made to local people and communities?

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* 8. Please share any further information on how your STAR has had a positive impact:

Thank you for nominating your STAR. We will be in touch through the contact details you have provided us.