2017AWARD NOMINATION FORM /

Before you fill in the nomination form

It is essential that you read all the information provided with this nomination form.
Check any eligibility requirements for this award and carefully consider the selection criteria.
Contact staff of the Australia Council to discuss your nomination, if necessary (toll-free 1800 226 912).
Before you send in your nomination make sure
You have answered all the questions that you are required to answer on the form.
You have signed the form.
You are submitting ONE original copy of your nomination form without staples or binding and not in a folder. If necessary, use paperclips to keep loose pages together.
Your nomination form is typed or printed in black ink on one side of the page only and is on white A4 paper.
You are including in the same envelope or package as your nomination form, copies of all the required support material for the category to which you are applying.
You have kept a copy of your nomination for your own records.
Privacy and Freedom of Information
The information you provide in your grant application or funding submission is used when processing and assessing your application or submission. All personal information you provide is dealt with by the Australia Council in accordance with the Privacy Act 1988 and its Privacy Policy. To help promote Australia's contemporary arts, the Australia Council distributes information concerning successful applications and submissions to the Commonwealth and State or Territory governments, national and local media and the general public. It also publishes this information in the Australia Council's Annual Report and on the Australia Council website. The Council will not use personal information for any other purposes and will not disclose it without consent.
The provisions of the Freedom of Information Act 1982 apply to documents in the possession of the Australia Council.
Please send your nomination to:
Executive Assistant
Grants and Engagement
Australia Council for the Arts
PO Box 788
Strawberry Hills NSW 2012
Note:Printed applications and support material must be postmarked on or before the closing date. We do not accept applications or application support materials postmarked after the closing date. We also do not accept applications or application support materials that are emailed, faxed or delivered by hand to our offices.

Which award?

Which award are you nominating someone for? You may only nominate someone for ONE award. All Australia Council awards close the 4 October 2016.
Aboriginal & Torres Strait Island Red Ochre Award
CACDRos Bower Award
CACDKirk Robson Award
Australia Council Award for Lifetime Achievement in Literature
Don Banks Music Award
Visual Arts Award
Dance Award
Theatre Award
Emerging and Experimental Arts Award

The nominator’s details

Your name
Title: / Mr / Ms / Other (specify):
Given names: / Family name:
If you are nominating on behalf of an organisation (otherwise skip to next question)
Name of organisation:
Your position

If you are nominating as part of a group(otherwise skip to next question)

Name of group:
Your role
Street address(or your organisation’s street address if you are nominating on behalf ofan organisation)
Street:
Suburb: / State: / Postcode:
Country:
Postal address(if same as street address, write ‘as above’):
Suburb: / State: / Postcode:
Country:
Contact details
Tel (Bh): / () / Tel (Ah): / ()
Fax: / () / Mob:
Web:
Email (please write clearly):
Nominator’s name
Who are you nominating?
Please provide contact details for the person you are nominating for this award. These details will be used only in the event of this person being offered the award.
Name
Title: / Mr / Ms / Other (specify):
Give names / Family name:
Street address
Street:
Suburb: / State: / Postcode:
Country:
Postal address(if same as street address, write ‘as above’):
Suburb: / State: / Postcode:
Country:
Contact details
Tel (Bh): / () / Tel (Ah): / ()
Fax: / () / Mob:
Web:
Email (please write clearly):

About the nominee

In a separate attachment of no more than 2 A4 pages using Arial 12-point, single line spacing, please provide your reasons for nominating this person. Keep in mind the criterion and information on the website for this award.

Please indicate how many pages you have attached:

Nominator’s name:

Seconders and other supporters of this nomination

Please provide the name of the person who has agreed to 'second' your nomination. You may also supply the names of other people who support this nomination.

If your nomination is successful we will contact the seconder and any other listed supporters to invite them to the award event.

Seconder:

Name: / Phone: / Email:

Other supporters of this nomination (optional)

Name: / Phone: / Email:
Name: / Phone: / Email:
Name: / Phone: / Email:
Name: / Phone: / Email:
Name: / Phone: / Email:
Name: / Phone: / Email:
Name: / Phone: / Email:
Nominator’s name:

Support material

Many Australia Council awards require you to provide support material with the nomination. It is your responsibility to ensure that you have included ALL the correct support material for the award to which you are nominating. Required support material comprises part of the nomination for assessment. If you are unsure please refer again to the award guidelines or speak to a project officer.

Please list below each item you intend to send with this nomination. Note that your support material will not be returned to you unless you make a specific request to Australia Council staff.

What support material am I providing?(eg written material, images, songs, letters of confirmation etc) / Record the format this material will be in(eg DVD, CD, book etc.) / Title, brief description and how this material is relevant to this nomination.

IMPORTANT! Have you checked the type and quantity of support material you need to supply for this award? If not, please check the guidelines.

Nominator’s name:

Certification of your nomination

I, / certify that…
The nominee is an Australian citizen or has permanent residency status in Australia
I have read the guidelines for this award
I understand that any information given to me by a Council, panel or staff member should be seen as information only and that I should not alter my circumstances or act upon expectations arising from such information; and
That to the best of my knowledge the statements in this nomination are true.
I acknowledge and agree that I provide my details to the Australia Council to be used in accordance with its Privacy Policy for purposes including:
1) to meet the Australia Council’s statutory reporting obligations
2) to monitor and report on the effectiveness of Australia Council funding programs
3) to assess the effectiveness of our administrative processes including training and system testing by Australia Council staff.
Signature: / X / Date: / / / /
Name in full:
Position in organisation (if relevant):