Citizen of the Year Awards Nomination Form

Required fields are marked with an asterisk (*).

CITIZEN OF THE YEAR AWARDS NOMINATION

Award Category (select one) *

Citizen of the Year
Young Citizen of the Year
Community Event of the Year
Community Volunteer of the Year

Full name of person or name of community event you are nominating *

Is the person being nominated an Australian Citizen? *

Yes
No
Unsure

How has the person or event contributed to the Roxby Downs Community? * maximum 3000 characters: additional material may be uploaded below

How has the nominee demonstrated active citizenship and enhancement of community life? * maximum 3000 characters

How has the nominee's contribution been recognised elsewhere? * maximum 3000 characters

Upload a file (this may be more info about your nomination, photos, newspaper clippings and the like). Maximum five A4 pages, minimum font size 10 point

The contact details of the person/event you are nominating:

Email * Email address of the person/event you are nominating

Mobile * Enter the person's mobile number without spaces

Address line 1 * Enter the person's address

Address line 2

Suburb

Postcode

Date of birth *

Nominator (your details)

Nominator name * your full name

Phone number of nominator *

Nominator email *

Referee

Name: *

Phone: *

Email: *

Occupation:

What is the referee's relationship to the nominee? *

What can the referee comment on? *

Community

Citizen of the Year Awards Nomination Form

Contact Council

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