Citizen of the Year Award Nomination

Required fields are marked with an asterisk (*).

Categories

Award Category Which category would you like to nominate

Nominee Details

Name * Please insert the name of the person you would like to nominate

Position/Organisation (Optional)

Address Line 1 *

Address Line 2 *

Phone (home) *

Phone (mobile)

Date of Birth * This field is required for Young Citizen of the Year but also preferred for Citizen of the Year

Day Month Year

Country of Birth

If not Australia, is the person being nominated an Australian Citizen?

Reason for nomination (500 characters) * How has this person/organisation contributed to the community?

Please list any other contributions and/or achievements (500 characters) Additional Material may be attached if required

Attachments

Nominator Details

Name * Your Name

Address Line 1 *

Address Line 2 *

Telephone (home) *

Telephone (mobile)

Email * please insert your email address

Date of nomination *

Day Month Year

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