Newcastle Community Consultative Committee on the Environment

Nomination for membership

The NSW Environment Protection Authority (EPA) is seeking community, environment and industry representatives to join the Newcastle Community Consultative Committee on the Environment.

The Committee’s role is to advise the Minister for the Environment and the EPA on matters of environmental concern in the Newcastle local government area.

The EPA welcomes applications from people who are able to demonstrate strong links to their local communities and the ability to represent their interest groups on matters relating to the environment.

The Committee’s Terms of Reference and other information about the Committee is available at www.epa.nsw.gov.au/NewcastleCttee/index.htm

The application form is available on the EPA website at www.epa.nsw.gov.au/newcastlecttee/nominations.htm. If you require further information on the Committee or wish to request an application form, please contact the EPA by email, or on 02 4908 6800.

Please complete all sections of the form.

The EPA may contact you or your referees if further information is required to support your nomination. All nominees will be advised in writing of the results of their applications.

Nominations must be lodged with the EPA by 5 pm on 11 December 2015 by email at or by post at NCCCE Nominations, NSW EPA, PO Box 488G, Newcastle NSW 2300.

1 of 5

Nomination form

Section 1. Details of person nominating

Please indicate (×) where required

Title: / Mr Ms Mrs Dr
First name:
Surname/family name:
Address:
Phone: / Work Home
Mobile:
Email:

Section 2. Position

Please indicate which positon best suits your skills and expertise

Please select one (x)

Community representative
Environment representative
Industry representative

Section 3. Employment (if applicable)

Please list details of relevant employment that may support your application. Include job title, responsibilities and expertise.

Section 4. Demonstrated connection to the community or stakeholder groups

Please list details of your membership of stakeholder groups that may support your application, for example, a local interest group, a management committee or government funded body. Please list the name and purpose of the group, your membership period, responsibilities and expertise.

Section 5. Demonstrated ability to represent your interest group.

Please describe relevant experiences and skills that demonstrate your ability to represent your interest group and to consider the views of other groups.

Section 6. Commitment to the purpose of the committee.

Please provide information that demonstrates your commitment to the purpose of the committee.

Section 7: Referees

Please nominate two referees who can support your application.

First referee’s details

Title: / Mr Ms Mrs Miss Dr
First name:
Surname or family name:
Contact details:

Second referee’s details

Title: / Mr Ms Mrs Miss Dr
First name:
Surname or family name:
Contact details:

Section 8: Declaration:

Name:
Date:

Environment Protection Authority
Web: www.epa.nsw.gov.au | Email:
EPA 2015/0837 | November 2015

Newcastle Community Consultative Committee on the Environment nomination form1 of 4