Australia Day Award Nomination

Required fields are marked with an asterisk (*).

Nominations are to be a maximum of 100 words and must address all of the point of the category entered. Dot points are acceptable.

Nominee Details

Nominee Name *

Nominee Date of Birth * DD/MM/YYYY

Nominee Postal Address *

Nominee Phone Number - Home

Nominee Phone Number - Mobile *

Nominee Country of Birth *

Is Nominee an Australian Citizen * If Country of birth not Australia - Is nominee an Australian Citizen

Nominator Details

Full Name *

Organisation Representing

Postal Address *

Email Address *

Phone Number *

Award Categories

Citizen of the Year 1) Demonstrated leadership, innovation, creativity and community contribution 2) Shown commitment to promote civic pride & active citizenship 3) Received any previous awards or recognition - personal, academic & professional achievements

Tick

Young Citizen of the Year 1) Demonstrated leadership, innovation, creativity and community contribution 2) Shown commitment to promote civic pride & active citizenship 3) Received any previous awards or recognition - personal, academic & professional achievements

Tick

Sports Person of the Year 1) Demonstrated application & dedication to sport 2) Received any previous awards or recognition - Personal & Professional achievements

Tick

Young Sports Person of the Year 1) Demonstrated application & dedication to sport 2) Received any previous awards or recognition - Personal & Professional achievements

Tick

Volunteer of the Year 1) Demonstrated leadership, innovation, creativity and community contribution 2) Shown commitment to promote civic pride & active citizenship 3) Demonstrated a high level of volunteer involvement-past contributions recognised but recent highly regarded

Tick

Community Event of the Year 1) Demonstrated benefits to the community eg. Leadership, innovation, creativity and pride. 2) Provided accessibility to the event for as many community sectors as possible. 3) Identified a need within the community for the event.

Tick

Community Initiative of the Year 1) Demonstrated benefits to the community eg. Leadership, innovation, creativity and pride. 2) Provided accessibility to the initiative for as many community sectors as possible. 3) Identified a need within the community for the initiative.

Tick

Nomination Summary

Email Submitted Data Send a copy of the submitted form to this email address.