OF THE YEAR 2011
Learners who have completed an
Learner details ILM qualification, endorsed or
development programme during
Title (Ms, Mr , Mrs etc)
the period 1 September 2009 to
First name 31 August 2010 are eligible for
entry. Previous regional/national
Surname winners cannot enter for the
Date of birth Award again.
Job title Nominated by
Company name Learners themselves
Company address ILM centres/providers
The overall ILM Learner of the
Year will be selected from the
winners of the following
Town County regions/nations:
Postcode Country • Wales
Telephone • Scotland
• Northern Ireland
Mobile • International
Email Regional/national winners will be
Which ILM qualification or programme did you complete (including level)? invited to a regional award
NB please copy the exact title from your ILM certificate ceremony in January/February
2011 and also to the national
ceremony, to be held in London in
What date did you start the course? April 2011, where the ILM Learner
of the Year prize will be presented.
What date did you complete the course?
ILM centre name (where you did your course)? The decision of the judges is final
and no correspondence will be
ILM centre number (if known)
ILM centre address Complete the form in Word format
and email to:
The closing date for entries is
Town County Thursday 30 September 2010
Late entries will not be considered.
Which region are you entering for? (delete as appropriate) You will receive an email
England Wales Scotland Northern Ireland International acknowledging your entry by
If the nomination is being made by an ILM centre or provider, please give your details below – Friday 1 October. You are
otherwise leave this section blank responsible for checking we have
Title (Ms, Mr, Mrs etc) received your entry.
First name Call 01543 266855 (Monday to
Surname Friday 9-5) if you have any
Mobile ILM reference number
ILM centre number
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Section B – the learner
Please tell us about your role and responsibilities and how your achievement of an ILM qualification/programme has contributed to the
success of your organisation, business or community (up to 500 words) 20 marks
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What is remarkable about the work you submitted as part of the ILM qualification or programme (eg did you achieve exceptionally high
marks, was the quality of your work commended and, if so, who by?) (up to 200 words) 20 marks
Why is your story an inspiration to others to learn and develop themselves (up to 200 words) 10 marks
Total word count for Section B
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Section C – referee (this section is only for learners who are self-nominating)
Please provide a short reference from a second person such as your line manager, your ILM tutor or assessor.
Name of referee
Signature of referee (can be electronic) Date
Relationship to nominee
Section D – publicity (to be completed by the learner or ILM centre/provider)
There is always media interest in the ILM Learner of the Year. Please give details of the person who can respond most effectively
to publicity enquiries, for example a marketing/communications officer or press officer at work or at your centre.
Daytime phone number
Mobile phone number
What is your local radio station?
What is your local newspaper?
I confirm that the information supplied above is correct to the best of my knowledge and that the statements are true and accurate. I also
confirm that I have read and agree to the conditions of entry into the ILM Learner of the Year 2011 (see front page of form).
Name in BLOCK CAPITALS
Signature (can be electronic) Date
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