Details of Nominee Nomination Award Type Citizen of the Year Senior Citizen of the Year Young Citizen of the Year Community Event of the Year Community Service of the Year Full Name of Citizen/Organisation/Event Contact Name (if nominating Organisation/Event) Residential Address Residential Street Address Town Post Code Postal Address Contact Number Email Address DOB of nominee (if nominating Young Citizen or Senior Citizen of the Year) Date of event (if nominating Community Event of the Year) Reason for Nomination Contributions to the community In 150-200 words, outline the contributions and activities undertaken by the person, community group or event you are nominating Leadership and community service In 150-200 words, outline the leadership and volunteer activities demonstrated by the person, community group or event you are nominating, including any details of past or present awards and memberships. Please attach any relevant information in support of your application for example; references, photographs or letters of support. One file only.256 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Referee in support of this application Referee Full Name Referee Position/Organisation Referee Street Address Street Address Town Post Code Referee Contact Number Referee Email Address This person may be contacted for further information Nominator Contact Details (person submitting this form) Nominator Full Name Nominator Position/Organisation Nominator Street Address Street Address Town Post Code Nominator Contact Number Nominator Email Address To receive a copy of these nomination details please provide your email address above. Privacy Statement: The personal details provided for the nominee will only be used to enable Council to determine the Award winners in each category and to contact the Award winners. The ‘reason for nomination’ details provided may be used by Council for the purpose of acknowledging the Award winners and may be disclosed to the media.Nominations for the Australia Day 2024 awards close 5pm Tuesday 10 October 2023. Leave this field blank
