The Order of Australia Association, Qld Branch – 2013 Senior Volunteer’s Award Nomination Form – page 3 of 3 pages
The Order of Australia Association, Queensland Branch
Senior Volunteer Award – 2013
Nomination Form
Background information:
The Order of Australia Association, Queensland Branch has established an annual Senior Volunteer Award to recognise the outstanding achievements of older people, particularly through their volunteer activities.
The Purpose of the Senior Volunteer Award is to recognise and reward outstanding voluntary contributions made by senior Queenslanders to their communities independently or through organisations with which they are associated.
The Order of Australia Association, Queensland Branch Committee (responsible committee) has responsibility for the conduct of the program.
Up to three awards may be made in each year, determined by a Panel of Judges selected by the responsible committee.
The awards will be presented at official functions of The Order of Australia Association, Queensland Branch.
Who may be nominated?
Any person, 65 years of age or over who resides in Queensland and is still be actively engaged in voluntary activities in the community. The person so nominated need not be a member of The Order of Australia Association.
A Senior Volunteer Award may be awarded only once to a person.
Who may submit a nomination?
Only a current member of The Order of Australia Association, Queensland Branch residing in Queensland
may make and submit a nomination.
Nominations must be completed, signed and dated using this nomination form and sent by post or email to:
By Post
Mr Geoff Cowles OAM,
Secretary,
The Order of Australia Association, Queensland Branch,
16 Kanturk Street, Ferny Grove, QLD 4055. Mark the envelope “Attention: Senior Volunteer Awards”
By email
Include in subject heading the words “ OAAQ Senior Volunteer Award Nomination”.
Nominations must be received no later than Friday 30 August 2013. Only one nomination per nomination form.
Please do not send any attachments with the nomination form
Senior Volunteer Award – 2013 Nomination Form
1. Details of the Association Member making the nomination.
Member’s full name……………………………………………………………………...... Award…………………….
Residential address……………………………………………………………………………...... postcode…………
Home ‘phone………………………………………….Mobile ……………………………………………………
Email address……………………………………………………………………………......
2. Who is the person are you nominating?
Title…………………Surname……………………………………..Given names………………………......
Any known Australian Honours awards?………………………………………………………………………………
Residential address…………………………………………………………………………………postcode………….
Home ‘phone………………………………………….Mobile ……………………………………………………
Email address…………………………………………………………………………………………………………. ….
Date of birth…………………………………( This is required to determine the nominated person is 65 years or older )
3. Who are two referees who can be contacted for comments about the nominee?
Please give us details of two referees we may contact to obtain comments on the contribution and service made by the person you are nominating. You should make sure each person is agreeable to being a referee.
3.1. Details of Referee 1.
Referee’s full name……………………………………………………………………...... Award…………………….
Residential address……………………………………………………………………………...... postcode…………
Home ‘phone………………………………………….Mobile ……………………………………………………
Email address……………………………………………………………………………......
3.2. Details of Referee 2.
Referee’s full name……………………………………………………………………...... Award…………………….
Residential address……………………………………………………………………………...... postcode…………
Home ‘phone………………………………………….Mobile ……………………………………………………
Email address……………………………………………………………………………......
4. Tell us about the voluntary activities of the person being nominated?
In the space provided on the next page please give us details of how the nominee has made an important contribution to the community as a volunteer. Include any positions held, activities undertaken, as well as the relevant dates. In your own words, tell us why you think the person you are nominating should be recognised with a Senior Volunteer Award. Always aim to address the principal selection criteria.
You might like to consider some of the following questions when writing about the nominee.
1. In what specific ways has your nominee been providing voluntary service?
2.For how many yearshas this service been provided by your nominee?
3.Approximately how many people would have benefited from your nominee's involvement with them?