If you know a Young Person that deserves nomination, then here's the place to do it. Simply fill out the following 2 page form, and then hit submit - that's all!

Unfortunately, I make a difference nominations are now closed. There will be a new campaign launched next year. Thank you for taking the time and effort to support the campaign this year, we hope it will prove to be a major success. Any information submitted using this form will not be processed.

Your Details (so we can contact you if we need to)

Your Name:

Your Email address:

Your Address:

Your Phone Number (must be 11 digits with no spaces):

Young Person's or Group's Details (so we can let them know that they've been nominated)

Young Person/Group's Name:

Young Person/Group's Email address (if known):

Young Person/Group's Address (use their school or youth group address if their address is not known):

Young Person/Group's Phone Number (if known):

Your Relationship to the nominated Young Person or Group:

Nomination Details

Why have you decided to nominate this Young Person or Group?

Please give some examples of how they have made a difference, including information on any personal challenges and circumstances they have faced, the impact they have had on others and the legacy they have left for the future:

Service monitoring information (not mandatory)

We would be grateful if you could complete the monitoring information below. This will help us to keep the campaign fair, and also to analyse areas that could be improved. All information is absolutely and completely confidential and will only be used to monitor and identify areas to improve. No personal information whatsoever (such as name and address, etc) will be released when reporting the findings.

Are you...?
Female
Male
Transgender

To which one of the following age groups do you belong?
0-15
16-24
25-34
35-44
45-54
55 and older

What is your ethnicity?
White British
White Irish
Any other White Background
Black Caribbean British
Black African
Any other Black background
Asian British
Asian Pakistani
Asian Bangladeshi
Any other Asian background
Mixed White/Asian
Mixed White/Black
Dual or multiple heritage
Any other mixed background
Chinese
Gypsy/Roma
Traveller
Any Other Background

Do you consider yourself to have a long term illness, health problem or disability which limits your daily activities or the work you do?
Yes
No

What is your Religion?
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
None
Other: Please specify:

How did you hear about I make a difference?
WFM
Facebook/Myspace
Email
Website
Outdoor Media - Bus shelters, posters etc
Word of Mouth
Through School
Youth Group
Other: Please specify:

Nominations will no longer be processed.