Are You Nominating an Individual Or an Organisation?

Nomination form 2015

Are you nominating an individual or an organisation?

Please indicate

Nomination details

Name:

(If nominating an organisation, please provide details for best contact person)

Organisation:

Position:

Street Address:

Postal Address:

Daytime contact number:

Email:

Award Category (please choose one only)

1. Leadership in community partnerships and transformation (Individual/Organisation)

1. Leadership in NDIS readiness (Organisation)

1. Excellence in individualised decision support and service provision (Individual)

1. Leadership in community accessibility (Organisation):

1. Excellence in employment inclusion (Individual/Organisation)

1. Excellence in promoting cultural competency (Individual/Organisation):

1. Excellence in Indigenous programs (Individual/Organisation)

Nominated by (your details, as nominator)

Name:

Relationship to nominee:

Address:

Daytime contact number:

Email:

How did you find out about the awards?

I have advised the nominee of my proposed nomination and gained the nominee’s consent. (Required)

Yes

No

(If nominating an organisation, consent needs to come from the Chief Executive Officer or equivalent for your nomination to be considered. Nominations will not be considered if consent is not given)

Nominee’s full name (please print):

Nominee’s signature and position (if relevant):

Please put your signature here:

(Please ensure you have read Eligibility and Conditions of Entry within the Award Guide 2015)

Nomination

All nominations need to address the following judging criteria:

(Maximum 1200 words to address all four criteria below)

1. The achievement/s of the nominee as relevant to the specific Award Category. Please include details on the context for the achievement/s, for example: the position of the individual, or for an organisation, the location, size and services provided by the organisation. (40%)

1. How the achievement/s of the nominee demonstrates true innovation (as described in the Award Guide) in providing support to people with disability. Innovation is of primary importance to your nomination. (40%)

1. How the achievement has made a real and tangible difference to the lives of people with disability, their families and/or carers. It is important to include information on when the innovative policies or practices were implemented and their outcomes. (20%)

1. Specific evidence and examples of the nominee’s achievements in relation to the subject of this nomination. This may include but is not limited to case studies; project deliverables; outcomes; key performance indicators met; data findings or evaluations. Future planning information may also be included.

Please complete the information required on this form, sign and attach it to your nomination.

Written (must be legible), typed or non-text (ie. multimedia, audio) nominations will be accepted but must be accompanied by a completed and signed nomination Form.

Complete the nomination form and submit by.

Submit by post, fax or email

Ms Ashley Kadib

Sector Development (Administration and Policy) Officer - National Disability Services

GPO Box 2687, Sydney NSW 2001

Email: , Fax: 02 9256 3123

Thank you for taking the time to make this nomination. Your nomination will be acknowledged within 10 days of receipt.

This information submitted in this nomination form will be held in confidence and is subject to the provisions of the Privacy Act.