H4H Community Awards Nomination Form

Please use this form to submit a nomination for an Heart 4 Harlow Community Award.  When received the nominee will be informed of their nomination.  The final decision about who is the winner and runner up for each category will be decided by the Core Groups in December.

Your Name (This will be published on the website):*
Your email address (This is for us to contact you about your nomination only and will not be published).:*
Nomination Category:*
Arts, Culture, Education and Sport
Health & Wellbeing
Churches and Chaplaincy
Type of Nomination:*
Name of person or organisation nominated:*
Nominee email address or telephone number (Please ensure you have permission to share this):*
Please describe why you would like to nominate this person or organisation in up to 250 words:*
I am happy for my details to be held by Heart 4 Harlow to enable them to contact me about this nomination. I also confirm that I have obtained permission form the nominee to share their contact details.
Please enter the verification number:*
nine seven eight three two
* Required Fields