Kempsey Shire Council Australia Day Awards
2017 nomination form

Australia Day 2017 Award nominations open

It is very important that we recognise and acknowledge the contributions individuals and community groups make to the fabric of our community.

Kempsey Shire Council is now calling for nominations for the 2017 Australia Day Awards.

Awards will be presented in three categories:

  • Citizen of the Year where they are at least 27 years old on 26 January 2017
  • Young Citizen of the Year where they are between the ages of 12 and 26 on 26 January 2017
  • Volunteer of the Year
  • Community Group of the Year

You can download a nomination form, contact Customer Services on 6566 3200 or complete on online form. You can also mail your form to Australia Day Awards, Kempsey Shire Council, PO Box 3078, West Kempsey NSW 2440 or deliver it to the Customer Service Centre.

Nominations will close 4:30pm, Monday 5 December 2016.

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Online form

Nomination for:

Citizen of the Year
To be eligible nominees must be an Australian citizen, 27 years and over on 26 January 2017 and may have made contributions to either (or a combination of): community service, sporting achievement, cultural or artistic achievement, scholarly achievement, special achievements, involvement in charities and fundraising.

Young Citizen of the year
To be eligible nominees must be an Australian citizen aged 12 to 26 years on 26 January 2017 and may have made contributions to either (or a combination of): community service, sporting achievement, cultural or artistic achievement, scholarly achievement, special achievements, involvement in charities and fundraising.

Volunteer of the Year Award
To be eligible nominees must demonstrate an outstanding contribution to our community through volunteering in areas as diverse as emergency response, providing support to those who are disadvantaged or elderly, growing the arts, historical and cultural connections, environment, working within schools and sporting clubs, and ensuring that our towns and villages grow and prosper.

Community Group of the Year Award
To be eligible nominated groups must have delivered an outstanding contribution in an area such as community service, sporting, cultural, artistic or environmental activities.


I would like to nominate:
Name/organisation:
Address:
Suburb:
Postcode:
Telephone:
Date of birth:
 (dd/mm/yy)
Age:

Is the nominee an Australian citizen? Yes      No


Persons who may be contacted for further information

Contact No. 1

Name:
Position/organisation:
Relationship to nominee:
Address:
Telephone:

Reason for nominating – how has the person/organisation contributed to the community?

Write a 100 to 400 word submission outlining the nominee’s background, achievements and reason for being nominated which may include:

  • Community service
  • Scholarly achievement
  • Awards and nominations received
  • Contribution to local employment
  • Sporting achievement
  • Special achievements e.g. acts of bravery, kindness
  • Contributions to the local environment
  • Contribution to local education
  • Cultural or artistic achievement
  • Involvment with charities and fundraising
  • Contributions to Aboriginal people
  • Years of service

Details of person submitting this nomination
Name:
Address:
Telephone:
Position/organisation:
Email:
Date:
 

Nominations close at 4:30pm on Monday, 5 December 2016