Nomination Form for Kingborough Awards 2021 |

Completing the Form

Please read the information on the Kingborough Community Awards website before you complete this nomination form. Make sure you have read and understood the criteria required for each category, and provide as much detail as you can. The general conditions of entry and selection criteria can be found at www.kingborough.tas.gov.au/kingborough/community-services/awards-ceremonies-3/kingborough-awards/. Nominations close at midnight on Monday 16 October 2023.

Nomination Category*

Nominee Details

Who are you nominating?

Title

Name of Nominee*

First Last

Organisation / Position

Address*

Street Address Address Line 2 City ZIP / Postal Code

Home Phone

Mobile

Work Phone

Email

Postal Address (if different from street address)

Street Address Address Line 2 City ZIP / Postal Code

Date of Birth

Young Citizen of the Year nominees only.

Referee Details

Please provide details of one referee who is available to be contacted for further information regarding the nomination. Alternatively you can upload a letter of support from at least one referee who is able to make direct comment on the contribution and service of the person or group nominated.

Title

Name

First Last

Organisation / Position

Address

Street Address Address Line 2 City ZIP / Postal Code

Home Phone

Mobile

Work Phone

Email

Postal Address (if different from street address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Referee Letter Upload

Drop files here or

Max. file size: 64 MB, Max. files: 3.

Nominator Details

Title

Name*

First Last

Organisation / Position

Address*

Street Address Address Line 2 City ZIP / Postal Code

Home Phone

Mobile

Work Phone

Email*

Postal Address (if different from street address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about these awards?

About your nominee

Please use this section to tell us about your nominee - the questions below are a guide to what sort of information we need. You can upload an attachment or fill it in online. • In what area has your nominee excelled? (social, environmental, business, the arts, culture, sports) • What has been their contribution to Kingborough? • How have they gone about it? • What qualities have they displayed? • How long has their contribution continued? Please include as much information as possible. You are encouraged to attach extra pages and supporting material.

Nomination

You can paste your nomination here or upload your information below.

Nomination and/or supporting material

Drop files here or

Max. file size: 64 MB, Max. files: 3.

Privacy Statement

Completion of this form may require the disclosure of personal information. The intended recipients of this information are officers of the Kingborough council in order to advance the purposes of this form and to carry out Council business. The Personal Information Protection Act 2004 and Council’s Privacy Policy regulate the use of this information, which will not be disclosed to any other party, except with your permission, or if required or authorised by the law. You may make application to access or amend personal information held by Council by contacting the Customer Services Team on (03) 6211 8200. Should you not provide the information sought, Council will not be able to process this application.

More from this section

Nomination Form for Kingborough Awards 2021

Kingborough Community Awards 2023

Completing the Form

Nominee Details

Referee Details

Nominator Details

About your nominee

Privacy Statement