Nomination Form 

You can download a Nomination Form here. Please complete it as fully as you can and email it to: info@halifaxcivictrust.org

NOMINATION FORM: CLICK TO DOWNLOAD

Or you can copy the form below, complete it, and email it to us info@halifaxcivictrust.org

Blue Plaque Nomination Proposal Form

We welcome nominations for individuals, groups, or events with a significant connection to Halifax. Please complete this form with as much detail as possible. We may not be able to support every application.

1.     Your Details

Name: _________________________________________

Address: _______________________________________

Telephone: _____________________________________

Email: _________________________________________

Date of Submission: ____ / ____ / ______

2.     Nominee Details

Name of Person / Group / Event Nominated:

Dates They Lived (if known):

3.     Connection to Halifax

Describe their link to Halifax (e.g., place of birth, residence, workplace, or key activity):

4.     Historical Significance

Explain their historical connection to the town:

5.     Contributions and Achievements

Detail their significant contributions to Halifax or beyond:

6.     Other Notable Aspects of Their Life

Outline any other noteworthy achievements, milestones, or recognition:

7.     Supporting Information

Please provide references, sources, or additional information (books, articles, websites, archives, etc.):

8.     Proposed Location

Suggested location of the plaque (address/building) including a postcode:

Has agreement of the owner been sought?  o Yes           o No            o In progress

9.     Sources of Funding

How will the Blue Plaque be funded/sponsored?

10. Declaration

I confirm that, to the best of my knowledge, the information provided is accurate.

Signature:

Date: ____ / ____ / ______

Please return this form to:
info@halifaxcivictrust.org

We aim to acknowledge nomination requests within one week and respond to all requests with a decision within 6 weeks. Decisions are made by the Halifax Civic Trust committee.

Thank you for your submission.