Online Form - Dandjoo Day » Shire of Gnowangerup

Nomination Type*

Community Citizen of the yearCommunity Group or Event of the yearSenior Citizen of the yearYoung Citizen of the year

Name of person/group being nominated*

Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Telephone*

Reason for nomination

Tell us about your person/group you are nominating. Why do you feel the nominee should receive an award, and what are the contributions/outstanding achievements for the nomination?

How have they demonstrated excellence to the community or in their sporting field?

Please detail the specific community service such as working for a local charity, the length of time, and how often service is given. You may also like to include such information as how the person contributes to the community; other significant contributions or achievements and past and present membership of community/sporting/professional bodies etc.

Please include as much information as possible so the nominee has the best change of being selected.*

How is the nominee an inspirational role model for their community? How have they gone above and beyond their normal employment/volunteer duties or shown leadership or other outstanding qualities? What impact or contribution did the actions of the nominee have on the community?*

Other Significant contributions and achievements?

Any achievements or representation at a higher level, e.g. zone, regional or state sporting activities etc.*

Any additional or supporting information?

Please include:

Any memberships of community/sporting/professional organisations and the details of any positions held by the nominee, e.g. secretary, chairperson etc.

Any awards or other nominations the nominee has received from those memberships and when.

Please use this space for any additional information you feel may assist in the judging of your nominee. Alternatively attach supporting documentation for the judging panel to consider.*

Nominated by:

Club/Group*

Position:*

Signature*

Telephone*

Email*

Note: Please attach any further information which may be relevant to the nomination.*

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