2018 Ministers’ Awards for Women in Local Government

NOMINATION FORM

Nominee Details
Name:
Council:
Position:
Phone Number:
Email Address:
Council Classification
(see separate council classification list - available at www.olg.nsw.gov.au/our-minister/ministers-award-women-local-government) / Metropolitan
/ Regional/Rural

Award category (please indicate one category)
Category 1 / Elected representative / Mayor
/ Councillor

Category 2 / GM/Senior Staff Member /
Category 3 / Non-Senior Staff Member /
Category 4 / Women in non-traditional roles* /
Category 5 / Women in traineeships or apprenticeships /
Mandatory criteria
The nominee is a current female member of staff, a female elected representative or an Administrator of a NSW council. Elected representatives and Administrators must have served during 2017, however do not necessarily have to be serving following the September 2017 Local Government elections. / Yes
/ No

*A role that is traditionally held by men where the nominee is the first to enter into that role at their Council or is breaking down gender stereotype barriers and conventions to perform the functions of any given role.

Nominee declaration
  • I give consent for details about my achievements relating to this nomination, including any details contained in the nomination form and photographs taken at the Awards ceremony, to be used by the NSW Government, ALGWA, LGNSW and/or LGPA for the purposes of showcasing and promoting the achievements of women in local government.
  • I confirm that the information provided about me in this nomination gives a full and complete picture of my achievements relating to this Award, and accurately reflects the facts.
  • I understand that I or my council is responsible for covering the costs of my attendance at the Awards ceremony, due to be held in Sydney on 7 March 2018, and that my Manager/Supervisor and General Manager is aware of my nomination.
  • I understand that I am not eligible to receive an award for a category in which
    I have previously been awarded.
Signature of Nominee (required) Date
Closing date for nominations is 21 December 2017

Eligibility and selection criteria

To be eligible for consideration for an Award, the nomination must:

 Provide a summary of at least one specific example (agreed by the nominee and nominator) to support the nomination, demonstrating tangible outcomes achieved and outstanding performance.

 Demonstrate how all criteria (1 to 3) are met.

 Be received by the closing date (21 December 2017).

The judging panel will be looking for individuals who have gone above and beyond their expected role to make a significant contribution to their council, their community and/or the local government sector in NSW.

Please note: information on previous years' winners can be found on the Ministers' Awards for Women in Local Government webpage at www.olg.nsw.gov.au/our-minister/ministers-award-women-local-government.

Example
Please provide a brief summary of the example that is being provided in support of this nomination. The example must demonstrate that the nominee has gone above and beyond their expected role to make a significant contribution to their council, their community and/or the local government sector in NSW.
200 words (maximum)
Enter Text Here
Statement against the criteria
1 / What outcomes were driven / achieved by the nominee in particular?
Please provide a summary of outcomes achieved for the Council, the local government sector, and/or the community more broadly. What was the nominee’s role in achieving the outcomes? What made the project / activity unique?
100 words (maximum)
Enter Text Here
2 / How has the nominee provided inspiration, innovation and/or lead by example?
Please provide specific examples of how the nominee has provided inspiration, innovation or has lead by example. Who did they inspire? How did they demonstrate leadership?
100 words (maximum)
Enter Text Here
3 / What has the nominee done to further the cause of women?
Please provide specific examples of how the nominee has furthered the cause of women. For example, have they participated in activities to increase women’s participation in local government or within the community? Have they challenged gender stereotypes and conventions?
100 words (maximum)
Enter Text Here
Details of Nominator and Seconder
Name of Nominator: / Name of Seconder:
Position: / Position:
Organisation: / Organisation:
Phone Number: / Phone Number:
Email Address: / Email Address:
Signature of Nominator: (required) / Signature of Seconder: (required)
Date: / Date:

How to submit your nomination

Please return the completed and signed form by email to or by post to Ministers’ Awards for Women in Local Government, Office of Local Government, Locked Bag 3015, Nowra NSW 2541 no later than 5:00pm on 21 December 2017.

Enquiries

For enquiries, please contact Kathryn Alorati at the Office of Local Government on
02 4428 4100 or .

2018 Ministers’ Awards for Women in Local Government

Nomination Form

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