Nominate
I have read the Terms and Conditions for the nominations

Nomination Form

Please provide details about the nominee and yourself in the fields below. All mandatory fields (*) should be completed.


Education
The candidates are required to have the following as a minimum;
  • GCSE category:
               8 A* to B or equivalent
  • A levels category:
               3 (A to C) or equivalent
  • Degree category:
               2:1 & age strictly under 25
Award  * 
Institute  * 

Deen
This section is not required but may raise the nominee’s profile.
Daily Prayers   
Recitation   
Please list any other special characteristic, qualification and/or achievement in the area of Deen
Other   
Maximum 100 words allowed.

Sport
This section is not required but may raise the nominee’s profile.
Sport played   
Level at which played   
Name of Club   

Art
This section is not required but may raise the nominee’s profile.
Chosen stream   
Briefly state your accomplishment in the selected art stream
Achievement   
Maximum 100 words allowed.

Adversity
Exceptional circumstances
Please clearly and concisely state the exceptional circumstances faced by the candidate indicating their contribution and/or demonstration of ability to deal with extreme and adverse situations.

Maximum 250 words allowed.

Extra Curricular
List any additional achievement that you wish to support your application with.

e.g. Volunteering, charity work, scout activities etc. Maximum 100 words allowed.

Personal Details of the Nominee
First name of your nominee  * 
Second name of your nominee  * 
Nominee’s age  * 
Nominee’s guardian   
Guardians contact number   
Nominee’s ethnicity  * 
Nominee’s school  * 
Address of your nominee
Address Line1  * 
Address Line2  * 
County  * 
Post Code  * 
Contact number of your nominee  * 
Email address of your nominee  * 
Reason why they deserve the award.  * 
Please include as much detail as possible. Maximum 500 words allowed.

Personal Details of the Nominator
Your first name  * 
Your second name  * 
Your relationship to the nominee   
Your Age  * 
Parent or guardian's name   
Guardians telephone number   
Your address
Address Line1  * 
Address Line2  * 
County  * 
Post Code  * 
Your daytime telephone number  * 
Your email address  * 
  
A project by Islam Channel in association with Islamic Help and The Dawah Project