Name of Nominee
Contact Name / Company Position
Postal Address
Suburb State Postcode
Telephone (Work) / (After Hours)Mobile
Categories Nominated (Place Yes next to appropriate category)
Community of the Year Award Population Under 15,000 Population Over 15,000
Nominator Information
Name of Nominator (if different from above)
Company/Position
Postal Address:
Post Code
Telephone (Work) / (After Hours)
Mobile / Email
Is the Nominee aware of nomination? (State Yes/No)
Please advise the following of judging results (State Nominator/Nominee)
Declaration
I have read and understood the entry conditions relating to the Regional Achievement & Community Awards for NSW and ACT and accept the judges’ decision is final. Attached is a summary with supporting documents.
Name
Date
How did you find out about the awards? (TV/Radio/Paper/Other)
Referees
Please indicate two people who are conversant with the nominee’s achievements and who would act as referees for this nomination
1. Name
Company/Position
Postal Address
Postcode
Telephone (Work) / (After Hours)
Mobile / Email
2. Name
Company/Position
Postal Address
Postcode
Telephone (Work) / (After Hours)
Mobile / Email
Q1. 100 Word Summary/Bio (for media & publicity purposes):
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Q2. 2,000 Word Update for previous nomineesThis question is applicable if you nominated or were nominated last year, we require only a 12 month update of up to 2,000 words, this will be submitted to the judges with your previous year’s nomination. The below criteria does not need to be addressed again if you nominated last year. If this is a new nomination, please go directly to Q3 and complete the application form).
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Q3. Detail the organisation/project and the aims and objectives:Type Here:
Q4. Community structure i.e. incorporated shire or organisational structure:Type Here:
Q5. Outline the organisation/project length of service to the community:Type Here:
Q6.Outline who has benefited for the community or groups services and detail the services provided:Type Here:
Q7. Discuss all barriers encountered and how they have been overcome:-Environmental conditions, funding, volunteers etc
-Discuss methods/actions that have been put into place for future prevention.
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Q8. Identify range or groups and number of people involved within community group/project:-Outline committee member’s roles/responsibilities
-Outline communities roles/ responsibilities
-Describe projects and who are involved
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Q9. As the nominator describe the nature of your individual input and self development:- What role do you play
- What qualifications or further education do you have
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Q10. Discuss training, support and encouragement of community/group members:-What training programs are in place
-Discuss how this assists with supporting the programs/project/group
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Q11. Outline community challenges:-What are the impacts on the community
-Are there any financial benefits
-Outline how the community is encouraged to be involved
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Q12. How do you measure outcomes:-What practices are put into place to evaluate success of projects/programs
-Discuss outcomes that have been successful, and why
-What areas do you believe that the community/group can improve on and why
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Q13. Any other relevant information:Type Here:
**Please attach samples of work, press articles, letter of reference, photos and awards, where possible.