Leading Practitioner Award- nomination form
The 2015 Victorian Homelessness Achievement Awards will celebrate the exceptional efforts of specialist homelessness services, consumers and other community members to end homelessness in Victoria.
About the Leading Practitioner Award
This award will recognise a leading practitioner in the homelessness sector. It will be awarded to an individual who shows compassion to clients and professional commitment to their role. They will have demonstrated a willingness to go the extra mile, to keep the individual at the centre of their practice and actively incorporate consumer participation into their work.
Instructions and timelines
If you would like to nominate a practitioner for the award, please complete the attached form. You are able to self-nominate in this category. Please note that members of the judging panel, their organisations and immediate family cannot nominate or be nominated for an award.
The nominee must have at least two years’ experience in the homelessness sector.
You can type directly onto this form, or print the form off and fill in the details by hand. Please scan and send completed forms , or mail to:
Awards 2015
Council to Homeless Persons
2 Stanley Street
Collingwood VIC 3066
In order to be eligible for consideration, nomination forms must complete all fields and be received by 5pm, Wednesday 15 July 2015. CHP will acknowledge receipt of nominations within five working days.
Judging and award presentations
A panel of consumer, sector and government representatives will assess the nominations. The awards will be presentedat theCHP Statewide Homelessness Conference 2015, on Thursday 17 September 2015.
If you would like more information about the awards or assistance in completing the nomination form, please contact Trish Westmore, Capacity Building and Policy Officer, on03 8415 6207or via email .
Part 1: Your details
Name:
Organisation:
Position:
Address:
Telephone:
Email:
Part 2: Nominee’s details
Please provide the nominee’s contact details.
Name:
Organisation:
Position:
Address:
Telephone:
Email:
Has this nominee been formally recognised through any other awards or commendations?
☐No.
☐I’m unsure.
☐Yes. Please provide details:
Part 3: About the nominee
In no more than 200 words, please describe the role and activity or activities for which this personis being nominated. Please provide examples of their practice.
Part 4: Respectful practice
In no more than 100 words, please describe the activity or activities for which this person has demonstrated respect, compassion and professionalism when working with consumers, colleagues and other agencies. Please include examples ofwhere and when these activities took place.
Part 5: Dedication to their role
In no more than 100 words, please describe how the nominee has shown dedication to their role (such as going the extra mile for consumers, advocating for the sector, participation in groups or networks). Please include examples ofwhere and when these activities took place.
Part 6: Placing the consumer at the centre of their practice
In no more than 100 words, please describe how the nominee has shown a commitment to placing the consumer at the centre of their practice (such as promoting consumer participation, promoting consumer choice, advocacy work, exceptional follow up activities etc). Please include examples ofwhere and when these activities took place.
Part 7: Referee details
Please provide the details of two referees who can be contactedabout this nomination. At least one of these referees must be external to the nominee’s organisation.
Name:
Organisation:
Position:
Telephone:
Email:
Name:
Organisation:
Position:
Telephone:
Email:
Part 8: Declarations
Please ensure that the declarations below have been signed by the nominee and yourself.
Nominee or key contact person’sdeclaration
I agree to be nominated for a 2015 Victorian homelessness achievement award. I agree that the Council to Homeless Persons or its agents may use the information provided in this form to assess nominations for the awards and for publicity purposes associated with the awards. I consent to the Council to Homeless Persons or its agents contacting the people named in this form and seeking comment from them regarding this nomination. I acknowledge that the Council to Homeless Persons will store this information securely.
Name:
Signature:
Your declaration:
By submitting this nomination for the Victorian homelessness achievement awards I certify that all information provided is true and correct to the best of my knowledge. I agree that the Council to Homeless Persons or its agents may use the information provided in this form to assess nominations for the awards and for publicity purposes associated with the awards. I consent to the Council to Homeless Persons or its agents contacting the people named in this form and seeking comment from them regarding this nomination. I acknowledge that the Council to Homeless Persons will store this information securely.
Name:
Signature:
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