Sunshine Award Nomination Form

First Name *

Last Name *

Phone

Email *

Contact Me *

Please contact me if my PCT is chosen as a Sunshine Award so that I may attend the celebration if available.

I am (please check one) *

Patient

Family/Visitor

Staff

Volunteer

Name of the PCT you are nominating *

Unit where this PCT works

I would like to thank my PCT and share my story of why this PCT is so special *

Consent for storing submitted data *

Yes, I give permission to store and process my data