St Agnes Parish Council recognises that there are many selfless and hardworking people – of all ages – who give their time and resources to help their communities. The Council want to recognise this invaluable work by awarding certificates of recognition. Anyone can nominate a person for a certificate by submitting the following form describing their contribution – in no more than 100 words. Any person, however old or young, who has contributed to communities within the parish is eligible to be nominated.

You can complete the form below or download the pdf version for posting or delivery to the council offices.

Certificate of Recognition Application Form

This field is for validation purposes and should be left unchanged.
Name Of Nominee(Required)
Do you have the nominee’s consent to share their personal information with the Council?(Required)
If no, the Council will contact the nominee within 28 days to confirm they are happy to proceed and for their contact details to be held for this purpose only.
Is the nominee a child (under 18)(Required)
If yes, please ensure the contact information provided below is for their responsible adult, who has been informed in advance of the nomination.
What age group is the nominee in?(Required)
Email address of nominee
Which area(s) has the nominee undertaken their good work?(Required)
Name of nominator (you)(Required)
Email Address Of Nominator(Required)

Reason For Nomination

In no more than 100 words, please explain why you are nominating this candidate for recognition.
In no more than about 100 words, please explain why you are nominating this candidate for recognition.