Application FormThis award celebrates those everyday superheroes who have helped others to get others more active and have

encouraged healthy habits that have built physical activity into everyday life, whilst making a special effort to focus on positive mental health. Examples of these everyday superheroes could be but are not limited to; an organisation

or individual that can demonstrate mental health and wellbeing improvement through physical activity. The individual or organisation has to have been operational/ had an impact in the past 12 months.

Please answer the below questions. A mark out of 10 will be award for each question, with the maximum number of points being 60. The nominee with the highest points will win.

Your Details

Name: Relationship to the nominee:

Email Address: Phone Number:

Postcode: Where did you hear about the awards?

Superhero Details

Name:

Email Address: Organisation:

1. How has this everyday superhero taken positive steps to encourage those with mental health issues be more active? (max 200 words)

2. How has the everyday superhero made positive changes in tackling mental health issues? (max 200 words)3. Pow! How has this everyday superhero promoted benefits of physical and mental health? (max 200 words)4. What would their special superpower be and why? i.e. strength of power/ hypnotic ability to encourage

others (200 words)5. With great power comes great responsibility! What value has the everyday superhero added to the

community? (max 200 words)6. Any additional supporting information? (max 200 words)

Hold the date 25th September at Chester Racecourse for

the awards evening

You will also need to supply a video up to 90 seconds in length explaining why the everyday superhero should win. We are not looking for any Stephen Spielberg productions! Videos can

be as simply done as recorded on a mobile phone. Examples of themes to mention are:

Terms of Entering

All entries must be completed using an official Active Cheshire Awards entry form in order to be judged. These are available to download at www.activecheshire.org

Completed applications need to be sent to awards@activecheshire.org by midnight on Friday 14th June.

1. What has been achieved?2. How has it been achieved?3. What difference has it made?4. Who has benefitted?5. Videos can feature yourself or anyone who has benefited from the Everyday Superhero.6. Extra points will be awarded for creativity.

Terms and Conditions

We have 7 award categories for individuals/ organisations who can meet the requirements. The individual/ organisation must operate/ live in Cheshire West, Cheshire East or Warrington local authority areas.

A judging panel, selected by Active Cheshire will provide expert scrutiny to ensure transparency of the Awards. The judging panel reserves the right to ask for additional information from the individuals, and to make enquiries where appropriate. The judges’ decision is final and no correspondence will be entered into. All entries will be judged solely on the information and supporting evidence given.

Finalists will be announced via social media and emails.

All finalists will be required to supply a high resolution photograph or logo in JPG/ PNG format which may be shown during the presentation ceremony at the event and in promotional material. Finalists must be present or send a representation on the evening of the awards in order to be eligible to win the award. As part of the ticket purchased to be present at the awards, a three course meal will be included. All costs for the ticket is to solely cover the cost of the event.

There is no charge to make a nomination for the Awards. Nominations are open to all. Individuals can make as many nominations as they wish and may enter all categories where applicable.

You must declare as part of your application if there is any known conflict of interest with Active Cheshire and/ or Active Cheshire board and/ or staff. You must also declare if you have received and/ or given Active Cheshire any funding/ investment in the past 12 months.

We can provide reasonable assistance to those who need help filming, but may withhold the right do so.

Active Cheshire is an inclusive organisation committed to promoting and ensuring equality of access and opportunity of our services. Therefore should you need this in another format or language please do not hesitate to get in touch.

Please answer the below questions. A mark out of 10 will be award for each question, with the maximum number of points be 60. The nominee with the highest points will win.

Answers for the questions can be written in this section below

How has this everyday superhero taken positive steps to encourage those with mental health issues be more active? (max 200 words)

How has the everyday superhero made positive changes in tackling mental health issues? (max 200 words)

Pow! How has this everyday superhero promoted benefits of physical and mental health? (max 200 words)

How would you describe you/ them in 3 words?

What would their special superpower be and why? i.e. strength of power/ hypnotic ability to encourage others (200 words)

With great power comes great responsibility! What value has the everyday superhero added to the community? (max 200 words)

Any additional supporting information? (max 200 words)