Engagement Programs (Category 3)
2015 Nomination form
Submission deadline: 5.00pm, Friday 7 August 2015
Nominations can be for completed ongoing programs where the majority of the activity occurred between 1 July 2014 – 30 June 2015.
Projects can include (but are not limited to) the following:
· Community involved and culturally inclusive programs
· Innovative programs that meet your program or organisation’s priorities and objectives
· Programs strategically linked to school activities and the curriculum
· Corporate partnerships that have extended and developed audiences
· Capacity building programs that have increased repeat visitations
· Education resources and related in-house publications
· Innovative website and/or social media projects
Please tick the box for the award to which you are applying:
(A) Engagement Programs award for volunteer organisations with 2 or less paid staff in the entire organisation
(B) Engagement Programs award for small/medium organisations with 3 -10 staff in the entire organisation
(C) Engagement Programs award for large organisations with 11 or more paid staff in the entire organisation
Selection criteria
1. Quality of the program’s aims and achievements
2. Quality of evaluation processes and outcomes
3. Level of consultation with stakeholders
4. A well planned program that is clearly articulated in this application
Nomination details
Name of museum, gallery or Aboriginal cultural centre being nominated for the award:
Title of program:
Nominator details (Person completing this form)
Nominating Organisation (if different from above)
Contact person:
Position:
Phone:
Email:
Street address:
Suburb:
State:
Postcode:
Postal address:
Suburb:
State:
Postcode:
Full time paid staff equivalent that worked on this program:
Number of volunteers that worked on this program:
Program budget:
Annual visitation:
Program details
Provide a short description of your organisation. (Max 200 words).
(You may wish to include your organisation’s mission statement/vision).
Briefly describe the program (Max 100 words).
Who was the intended audience and what were the aims? (Max 100 words).
How successful were you in reaching your target audience? (Max 500 words).
(Be qualitative and quantitative in your analysis).
In what way was this program innovative? (Max 200 words).
Support material
The following support material must be submitted with your nomination:
· FIVE images or pages (maximum) of documentation which supports the application
AND
· TWO high quality images of the nominated program (300 dpi jpegs max. 2MB). These images will be used in promotional material and at the awards presentation.
Please refer to the 2015 Guidelines document for details on how to prepare and submit your support material.
Declaration by nominator
I give my assurance that, to the best of our knowledge, the information supplied in this nomination is true and correct at this date. I agree to abide by the IMAGinE awards’ Terms and Conditions of Entry.
I accept.
Date:
How to submit your nomination
Nominations and support material are to be submitted in an electronic format by email or post on USB or CD. Nominators who are unable to submit digital material must contact M&G NSW to discuss alternate arrangements.
To prepare your entry for submission save this document with your organisations name and category you are entering. Please use an underscore ( _ ) to separate words. For example: OurMuseumGallery_Category_3.doc
Nomination checklist
Completed nomination form
Completed payment details page
Required support material
Please submit your nomination to Museums & Galleries of NSW
Email submissions:
Posted USB/CD submissions: IMAGinE award nominations
Museums & Galleries of NSW
Level 1, The Arts Exchange, 10 Hickson Road
The Rocks NSW 2000
Organisation payment details
Organisation:
Contact person: Position:
Postal address:
Suburb: State: Postcode:
Phone:
Email: (Invoice/receipt will be sent to this address)
Entry fee levels
$30 – (A) Volunteer organisations with 2 or less paid staff
$40 – (B) Small/medium organisations with 3 – 10 paid staff
$50 – (C) Large organisations with 11+ paid staff
Total entry fee: $ (Including GST)
Payment details
Payment method: Cheque Invoice Visa Mastercard
Credit card no: CVC:
Card holder: Expiry date:
Terms and conditions
Tax invoices will be issued for all nominations. Nominations are not accepted without payment. Nomination fees are non-refundable. Your personal information will be stored in accordance with M&G NSW’s privacy policy. If you have any concerns please contact M&G NSW on 02 99252 8300or
AWARD NIGHT EARLY BIRD TICKET OFFER
ATTENDEE INFORMATION
First name: Surname:
Position: Organisation:
Address: Email:
Phone: Fax:
Dietary requirements:
EVENT COSTS
$49.50 (including GST) Early Bird Full price
$36.00 (including GST) Early Bird Concession price (volunteers, students and seniors)
PAYMENT INFORMATION
Method: Cheque Visa Mastercard Invoice
Cardholder:
Card no:
Expiry: /
Email: (Invoice/receipt will be sent to this address)
TERMS AND CONDITIONS
Tax invoices will be issued for all registrations. Registrations are not accepted without payment. Cancellations may incur a $15 administrative fee. Cancellations must be made more than three working days prior to the event or refund may not be issued. All details are correct at time of printing. For additional information please contact 02 9252 8300 or
STATISTICAL INFORMATION
M&G NSW values your privacy. Your responses to the following questions will not be used for any other reason than statistical research and will remain grouped. No identifying information will ever be used.
Region Age Gender Extra
Metro Sydney 15-25 Male Disability/special needs
Western Sydney 26-40 Female Non-English speaking background
Regional NSW 41-65 Aboriginal or Torres Strait Islander
Other 65+
How did you hear about this event?
M&G NSW e-newsletter Alert! Other e-newsletter
M&G NSW website Other website
Word of mouth Direct email
Other (please specify)
Would you like to subscribe to Alert! M&G NSW’s fortnightly e-newsletter?
Yes, please subscribe me
No, I do not want to be subscribed
No, I am already subscribed
RETURN INFORMATION
Museums & Galleries of NSW
Level 1, 10 Hickson Road, The Rocks NSW 2000
Email:
Fax: 02 9252 9866
Engagement Programs_2015