Lula Sandla Employee and Shareholder Nomination Form

Lula Sandla Employee and Shareholder
Nomination Form

Lula Sandla Employee and Shareholder Nomination Form

DETAILS OF EMPLOYEE OR SHAREHOLDER MAKING THE NOMINATION

Name(Required)

First Last

Telephone (w)

Telephone (c)(Required)

Email(Required)

DETAILS OF NOMINATED PROJECT

Current position held and Halls Group entity in which you are employed(Required)

Name of organisation and / or project (where applicable):(Required)

Non Profit Organisation (NPO/ NGO/ PBO) Registration Number (if applicable):(Required)

Description of the project and it’s location:(Required)

Your role / responsibility within the project:(Required)

Any challenges that the project has faced and how these challenges have been overcome:(Required)

Does this project currently have access to funds? Yes/No and How frequently are these funds made available?(Required)

Average number of hours that you work on the project per month:(Required)

Total years / months / weeks that you have been involved with the project:(Required)

RECIPIENTS/ BENEFICIARIES AND IMPACT OF NOMINATED PROJECT

Description of the recipients / beneficiaries (i.e. the people the project helps):(Required)

Number of direct recipients / beneficiaries:(Required)

What positive impact has this project had on the recipients / beneficiaries?(Required)

Why do you believe that this project deserves a Lula Sandla Award? What makes this project excellent?(Required)

REFERENCES

Please provide two references that we can contact for additional information regarding the project:

Reference 1

Name(Required)

First Last

Contact Number(Required)

Email(Required)

Relationship to individual / project:

Reference 2

Name(Required)

First Last

Contact Number(Required)

Email(Required)

Relationship to individual / project:

BANKING DETAILS PERTAINING TO NOMINATED PROJECT

Bank Name(Required)

Account Name(Required)

Bank Account Number(Required)

Branch Code(Required)

Name of Signatory(Required)

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Phone

This field is for validation purposes and should be left unchanged.