SCOUTS AUSTRALIA (ACT BRANCH)

ADULT RECOGNITION AWARDS

NOMINATIONFORM

BEFORE USING THIS FORM PLEASE READ THE FOLLOWING NOTES

This Form is for the nomination of an Active Leader, Other Member or Supporter for the Special Service Award or the Meritorious Service Award only.

Nominations for all other Adult Recognition Awards must be made on the Scouts Australia National Award Recognition Awards Nomination Form.

In completing this Form:

  1. complete the relevant sections with the evidence to support the nomination;
  2. send the completed form,along with the Extranet profile, to the Secretary of the ACT Branch Human Endeavour Recognition Committee (HERC) at:

For Nomination Guidelines, please see:

NOMINEE
Name
Title / First name / Surname / Postnominals
Appointment
Formation
Residential Address / Street : / Suburb :
State : / Postcode :
Core Module / Child Safe Scouting Completed: / Year Completed:
Core Module / WHS for ScoutingCompleted: / Year Completed:
Leader Qualification / Wood Badge Completed: / Year Completed:
AWARDS
Most recent Adult Recognition Awarded
Year Awarded
AWARD nominated this year
EVIDENCE OF SERVICE TO SUPPORT RECOMMENDATION
Writea short description of the contribution made to Scouting by the individual, demonstrating why the Nominee’s service is worthy of recognition. This might include such things as, has the nominee:
  1. Carried out his/her Scouting responsibilities to the highest standard and how this has contributed to youth membership growth or the wellbeing of Scouting?
  2. Demonstrated that they are a team player, how this has benefited Scouting generally, and fellow Adults in Scouting?
  3. Demonstrated leadership which has inspired enthusiasm among others?
  4. Provided ideas for the future direction of Scouting and effectively implemented these ideas?
  5. Contributed to wider Association events and activities beyond the level normally expected in the appointment or role?
If possible provide dates, events and places as appropriate and only refer to service and evidence since the Nominee’s most recent award. Please type directly in the space provided.
Note that the points above are intended to assist nominators in identifying the contributions that may justify recognition of the Nominee’s service. It is not necessary to offer details against every point!

CITATION SUMMARY (OPTIONAL)
A Citation will be prepared to accompany the Awards. If you wish you may provide a brief summary of the information outlined above to articulate why this award is recommended which will assist the writing of the Citation. It may be read out in support of the recommendation when the award is presented.

Now please go to the final page which must be completed with your recommendation.

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RECOMMENDATIONS AND ENDORSEMENTS
Nominator
Name
Position
Signature
Date
Branch Region Commissioner
Award Approved
Not Approved / (Award Approved)
Branch / ACT Branch
Name
Signature
Date
Branch Chief Commissioner
Award Approved
Not Approved / (Award Approved)
Branch / ACT Branch
Name / Rick Goode
Signature
Date

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