Ministers’ Awards for Women in Local Government 2015

2015 NOMINATION FORM
Closing date for nominations: Thursday, 12 February 2015
Nominee Details
Name
Council Name
Council Classification
(see separate council classification list - available on the Awards webpage) / Metropolitan
/ Regional/Rural

Nominated for type of Award
ELECTED REPRESENTATIVE / STAFF MEMBER
Category 1 / Category 2 / Category 3 / Category 4
Mayor
/ Councillor
/ GM/Senior Staff
/ Non-senior Staff
/ Non-traditional Role

Position held
Phone Number / Email Address
I giveconsent for details about my achievements relating to this nomination, including any photographs taken at the Awards ceremony, to be used by the NSW State 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 held on Tuesday, 3 March 2015.
Signature of Nominee(required) Date
Details of Nominator
Name / Position
Organisation
Phone Number
/ Email Address
Signature of Nominator(required) Date
Ministers’ Awards for Women in Local Government
2015 NOMINATION FORM

The application must:

demonstrate how both Criteria 1 and 2 are met to be eligible for consideration for an Award

be received by the closing date (Thursday, 12 February 2015).

Important: At least one specific example (agreed by the nominee and nominator) should be provided to support the nomination, demonstrating tangible outcomes.

For Criterion 2, please provide comments to each of the sub-headings (a)-(c) for the relevant category. Please limit comments to 100 words under each of the sub-headings.

Criterion 1 / The nominee is a current female member of staff or a female elected representative of a NSW council.(Elected representatives must have served during 2013) / Yes
/ No

Criterion 2 / The nominee must have demonstrated a significant contribution to their council, their community and/or the local government sector in NSW through one or more of the following:
Categories 1-3 / (a) / Achieving beneficial outcomes through an event or series of actions
(b) / Providing inspiration, innovation and/or leading by example
(c) / Working towards increasing the level of women's participation in local government elected, employed or volunteer roles
Category 4 / (a) / Achieving beneficial outcomes through an event or series of actions
(b) / Providing inspiration, innovation and/or leading by example
(c) / Challenging gender stereotypes and conventions

Please note: information on previousyears' winners can be found on the Ministers' Awards for Women in Local Government webpage at

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, or by fax to 02 4428 4199,no later than5.00 pm onThursday, 12February 2015.

For enquiries,please contact the Office of Local Government on 02 4428 4100.

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