SECTION 1 Nominee Organisation

Nomination Form

SECTION 1 Nominee Organisation

Tell us about the women’sorganisation you are nominating for the Honour Roll.

• Please print neatly using black/blue pen.
• If you are unsure of the spelling of any names, please mark the name with an asterisk *

Organisation name
Name of contact for organisation (if known)
Postal address
Home number / ( ) / Mobile
number
Business number / ( ) / Email address
Date the organisation was established
Details of previous recognition
Please select the category that best suits the organisation’s area of excellence:
 / Aboriginal affairs /  / Environment /  / Planning, engineering or architecture
 / Agriculture /  / Health /  / Police, emergency services or defence
 / Arts or media /  / Human rights /  / Science or medicine
 / Business or industry /  / Justice /  / Sport and recreation
 / Community service /  / Multicultural affairs /  / Tourism
 / Education and training

SECTION 2Nominator

Please provide your contact details to enable the Tasmanian Honour Roll of Women to seek further information if required.

Title (Miss, Mrs, Ms, Mr, Dr etc) / Family name
Given names
Postal address
Position/title / Organisation/
business name
Home number / ( ) / Mobile
number
Business number / ( )
Email address
Signature / ……………………………… / Date / ……/……/......

After completing this nomination form, please sign and forward preferably by mail to:
Tasmanian Honour Roll of Women

GPO Box 123

HOBART 7001

Or email to:

Please note

• Nominations are now open for induction into the Honour Roll in 2015.
• An independent judging committee will assess all nominations to determine the nominee’s suitability for inclusion on the Honour Roll. It is advisable to include as much detail as possible to assist the judges in reaching a decision.
• You are encouraged to include any supporting information such as newspaper or newsletter articles.

SECTION 3

Please provide details of the organisation’s significant contribution to the community, achievements, activities undertaken and the relevant dates of service. Also provide a brief statement about why you think this women’s organisation deserves recognition on the Tasmanian Honour Roll of Women. In preparing your statement, please review the selection criteria provided in this nomination form. This section should be typed if possible.

Note: if there is insufficient space, you may provide additional information on the back of this page or on separate sheets and attach them to this form.

Nomination process and selection criteria

Organisations and individual members of the Tasmanian community are invited to nominate a women’s organisation they consider to have made a significant contribution at a local, state or national level in their field of endeavour.

Nominations for women’s organisations should be for the overarching body, not subsidiary branches of organisations. Nominations for defunct women’s organisations will be accepted.

Supporting information is required and should be typed and not exceed 500 words.

Selection of women’s organisations will be guided by one of the following criteria:

• significant contribution to the Tasmanian community;
• historical and contemporary achievement in advancing social justice at a state, national or international level; or
• significant voluntary activity.

A panel of judges appointed by the Minister for Community Development, will base its decision on the selection criteria. Nominations should address as many of the selection criteria as possible.

Personal Information Protection Act 2004

The Tasmanian Honour Roll of Women is maintained in accordance with the Personal Information Protection Act 2004, which establishes a framework for the responsible collection and use of information by the Tasmanian public sector. All information provided by nominees and nominators is confidential and will only be used for the purpose of assessing Honour Roll nominations.

For those selected for inclusion on the Honour Roll, some of the information nominators provide will be used to develop a biography suitable for publication in a commemorative folder and on theTasmanian Honour Roll of Women website. As part of that process, a representative from the organisation will be asked to confirm the accuracy of the biography.

To find out more about the Honour Roll, including previous inductees, visit the website at: or contact us on 1800 204 224 or email