NOMINATION FORM
2016 Crows Nest
Community Awards
DETAILS OF PERSON OR GROUP BEING NOMINATEDSURNAME / GROUP / Title: (Please select)MrMrsMissMsNot Applicable
FIRST NAME(s) / DATE OF BIRTH : / / / AGE: / (for Junior Award only)
RESIDENTIAL ADDRESS
POSTAL ADDRESS
TELEPHONE (Daytime) / / (A/Hours) / (Mobile)
Is the nominee aware they have been nominated and would they accept the award if selected? rYes rNo
For the following Awards :
CITIZEN YOUNG CITIZEN
(26 years of age & over as at 26 January 2017) (Under 26 years of age as at 26 January 2017)
SPORTS AWARD - SENIOR (17 Yrs & Over) SPORTS AWARD - JUNIOR (Under 17 yrs as at 26/1/17)
COMMUNITY GROUP / EVENT CULTURAL AWARD
CROWS NEST DISTRICT including Hampton, Ravensbourne, Pinelands, Emu Creek, Anduramba,
Groomsville, Plainby, Coalbank, Thornville, Glenaven, Djuan & Haden
PERSON SUBMITTING NOMINATIONTitle: (Please Select)MrMrsMissMs
ADDRESS / POSTCODE
ORGANISATION REPRESENTED (if applicable)
TELEPHONE (Daytime) / (A/Hours) / (Mobile)
SIGNATURE OF PERSON SUBMITTING NOMINATION
Please tell us about your nominee on the next page. Provide as much detail as necessary; additional pages can be added
Collection Notice: The Crows Nest Local Australia Day Co-ordinating Committee is collecting your personal information in accordance with the Information Privacy Act for the purpose of assessing and awarding the Crows Nest Community Awards. The information provided in this nomination will be accessed by authorised members of the relevant Committee. The award recipient’s name and accomplishments may be provided to the media.
NOMINATIONS CLOSE: - 29th April 2016 (Round 1 Awards)
10th Oct 2016 (Round 2 Awards)
Send all nominations to Crows Nest Community Awards PO Box 144 CROWS NEST QLD. 4355
OR EMAIL TO:
NOMINEE DETAILSPlease tell us about your nominee in 400 words or less
For assistance in completing this section, please refer to “Selection Criteria” and “Hints”
Please briefly list up to 5 achievements of your nominee
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In 25 words or less, tell us why your nominee deserves an Australia Day Award:
OTHER PERSONS WHO MAY BE CONTACTED FOR INFORMATION ABOUT NOMINEE
NAME
ORGANISATION (if applicable)
POSITION
ADDRESS
PHONE (Daytime) / MOBILE
NAME
ORGANISATION (if applicable)
POSITION
ADDRESS
PHONE (Daytime) / MOBILE
G U I D E L I N E S
2016 Crows Nest
Community Awards
The Crows Nest Local Australia Day Co-ordinating Committee in conjunction with PCCN & Heritage Bank is proud to support the Crows Nest Community Awards. The awards are administered by the Crows Nest Local Australia Day Co-ordinating Committee.
The Citizen, Young Citizen, Sporting Award, Cultural Award and Community Group / Event will be presented to the successful local citizens and groups who have made outstanding contributions to their community. The awards will be presented on two separate occasions—the first ceremony being held as part of the Crows Nest Show festivities and at a second ceremony to be held in conjunction with the Community Dinner being held in October during the Crows Nest Festival Week.
A selection committee will view and judge each nomination and select an award category winner for each Award.
The Crows Nest Community Award Categories are:
· Citizen
· Junior Citizen
· Sports Award (Senior & Junior)
· Cultural Award
· Community Group / Event of the Year
All nominations will be considered for entry into the Australia Day Awards Nominations for 2017 for the Crows Nest Region.
ELIGIBILITY CRITERIA
CITIZEN
A person, who is 26 years of age and over, an Australian Citizen, residing in the defined area, who has either made a noteworthy contribution during the current year and/or given outstanding service to the local or regional community over a number of years.
YOUNG CITIZEN
A person, who is under 26 years of age, an Australian Citizen, residing in the defined area, who has either made a noteworthy contribution during the current year and/or given outstanding service to the local or regional community over a number of years.
SPORTS AWARD (Senior, 17 yrs & over : Junior, under 17 yrs)
A person or group who has achieved a noteworthy performance(s) in sport, or has made a significant contribution to the sport as a Coach, Official or Administrator during the past year
CULTURAL AWARD
A person who has made a noteworthy contribution to the cultural life of the community or an outstanding achievement in cultural activity(ies) during the past year.
COMMUNITY GROUP / EVENT
To be presented to an organisation based on:
· Its delivery of outstanding community service / benefit during the year.
· Its conduct of an outstanding community event during the past year.
CONDITIONS OF ENTRY
· Nominations must be submitted on official Crows Nest Community Awards forms.
· Nominations must be received by 5 pm on the closing nominated dates—29th April 2016 and 10th October 2016.
· In the event that no nominations are received in any of the categories, the relevant Committee reserves the right to extend the nomination period or make the award to an individual, event or group of its choice.
· Awards will not be granted posthumously.
· Sitting local, state and federal politicians and current vice-regal officers are not eligible.
· A person would not usually be awarded the same award more than once; however, a repeat award may be made in exceptional circumstances. In this case particular consideration will be given to work undertaken since the last time the person was awarded—the award should not be given twice in recognition of the same work. Community groups can be considered for repeat awards.
· Unsuccessful nominees from the first round of awards will also be considered in the second round of awards.
· Nominations should include the name and contact number of one referee that can provide supporting evidence to the nomination.
· The decision of the Local Crows Nest Australia Day Co-ordinating Committee is final and no correspondence will be entered into in regards to that decision.
SELECTION CRITERIA
2016 Crows Nest
Community Awards
The Award Committee will consider the nominee’s achievements in the year immediately prior to the receipt of the award (July 2014—Dec 2015), as well as their past achievements and ongoing contribution to the local community. The judging of the entries is made by the relevant Local Australia Day Co-ordinating Committee and is based on how each entry succeeds in reflecting the following values embodied in the award:
CITIZEN OF THE YEAR
Criteria to be used in assessing the Citizen includes:
• Nominee resides in the nominated CROWS NEST DISTRICT including Hampton, Ravensbourne, Pinelands, Emu Creek, Anduramba,
Groomsville, Plainby, Coalbank, Thornville, Glenaven, Djuan & Haden
• Nominee is 26 years of age and older as at 26 January 2017;
• Activities result in short and long-term benefits and promote the welfare and wellbeing of the (local) community;
• Providing a positive role model for others; and
• Contributions being completed on a voluntary basis or exceeding the normal requirements of the person’s paid work.
YOUNG CITIZEN OF THE YEAR
Criteria for assessing the Young Citizen of the Year includes:
• Nominee resides in the nominated CROWS NEST DISTRICT including Hampton, Ravensbourne, Pinelands, Emu Creek, Anduramba,
Groomsville, Plainby, Coalbank, Thornville, Glenaven, Djuan & Haden
• Nominee is younger than 26 years of age as at 26 January 2017;
• Activities result in short and long term benefits and promote the welfare and wellbeing of the (local ) community;
• Providing a positive role model for others; and
• Contributions being completed on a voluntary basis or exceeding the normal requirements of the person’s paid work.
CULTURAL AWARD
Criteria for assessing the Cultural Award includes:
• Level of contribution to, and achievement in, local or regional cultural life and activities. Examples include, but are not limited to: performing / visual arts, literary, and historical conservation.
SPORTS AWARD (Senior & Junior)
Criteria for assessing the Sports Award includes:
• Major sporting achievement or significant contribution to sports administration (including coaches and officials).
COMMUNITY GROUP / EVENT OF THE YEAR
Criteria for assessing the Community Group / Event of the Year includes:
• Delivery of outstanding community service;
• Purpose of event and outcome achieved;
• Impact of event/group activity on local or regional community;
• Level of community participation; and
• Reflection of Australian values.
H I N T S
2016 Crows Nest
Community Awards
HELPFUL HINTS
When you fill out the nomination form, there are a few things you should consider to ensure your nomination provides us with
enough information about the achievements of the person you are nominating. Here are some hints to help you get started:
• Fill out as much of the form as possible. Even if you do not know the person you are nominating well, try to provide as much detail as you can.
• If at all possible please include nominee’s date of birth. If you are not certain of the person’s date of birth, then make an educated guess and insert an approximate age.
• Include any supporting documentation with your nomination. This can include personal references, portfolios, resumes, newspaper articles, etc.
• Please do not nominate the same person more than once for the same award. Recipients are selected based on selection criteria, rather than the number of times they are nominated.
NOMINEE’S DETAILS
The nomination form provides space for the nominee’s details. In providing this information, consider the following:
• In what area and/or roles has the person excelled?
• How does the person stand out from the pack? How has their achievement/service been greater than what might be normally expected of a person their age and in their field? Focus on both the quality and quantity of their achievement/service.
• How much of their work has been voluntary, focused on helping others or making their local community a better place?
• Has the person overcome particular challenges or adversities to make their achievement? How difficult has their achievement been?
• How has the nominee shown achievement/service outside of their particular specialty? For example, personal interests and involvement in the wider community.
• How has the nominee’s achievement/service been acknowledged elsewhere - other awards, commendations etc.
• How does the person nominated make you proud to be Australian? Is your view shared by others in your community? If so, who?
• What personal qualities make the person inspirational?
• Why should other Australians look to the person as a role model?
• Has the person shown great bravery, vision or particular strengths of character?
SUPPORTING DOCUMENTATION
If you are nominating, you can attach supporting documentation to the form. Supporting documentation can include:
• Personal references • Portfolios • Resumes • Newspaper articles
PROVIDE EXAMPLES
Provide examples to support your statements for all of the above. Don’t just make a statement - demonstrate it with
examples. To help you get started, here is an example of an answer that provides a great amount of information:
At 22 years Christina is an outstanding young dancer and shares her passion for the arts with the community of Crows Nest, particularly through the local Dance Connection Company. Since 13 Christina has won overall best dancer in the Toowoomba Eisteddfod, and in 2002 obtained first place in the National Ballet Eisteddfod held in Perth. Christina has been accepted into the Australian Ballet Company but has decided to stay in the local area to teach dance to the youth.
Throughout her training she has faced the isolation of being a ballet dancer a long way from the big companies based in the southern states. She worked two part time jobs to raise the funds to travel south each Christmas to undertake intensive classes.
Christina is the lead dancer for the Youth Ballet Company and has recently choreographed two short ballets. Christina was the driving force behind a tour to Tenant Creek and to Alice Springs in September last year and she is planning a tour to Alice Springs again this year.
Christina is not only an exceptional dancer; she is committed to building the local arts community. All of Christina’s work with the Youth Ballet has been voluntary. I estimate that she has spent at least 20 hours per week for the past four years working with the younger dancers in the company.
Christina shows that the arts are alive and well in rural Australia. She continues to combine her talents and passion for the arts to promote dance.
Through my son who is a member of the Youth Ballet Company I can see that she has changed the lives of many young people. She has given them the opportunity to express themselves in dance and the company has grown as a result of her involvement.
All of the members and parents are inspired by her passion, drive and great skill as a leader and as a dancer. She is a role model to her younger dancers and I believe to all of those associated with the company.
She is an outstanding young Citizen.