Australia Day Awards Nomination Form

Form to make a nomination in our Australia Day Awards

Nomination Category*
- Citizen of the Year
- Young Citizen of the Year
- Community Group of the Year
- Community Event of the Year
To be eligible for Citizen of the year, the person must be 27 years or older on 26 January of the year of nomination.

To be eligible for Young Citizen of the year, the person must not be more than 27 years of age on 26 January of the year of nomination.
Name
First Last
Address
Street Address Address Line 2 Suburb Post Code
Email
Phone
Date of Birth*
DD slash MM slash YYYY
Contributions to the community for which the Individual or Group is being nominated for:
Additional material may be uploaded here to support the nomination.
Drop files here or

Max. file size: 64 MB, Max. files: 10.
Other significant contributions and achievements:
Past and present membership of community / sporting / professional bodies:
Details of the person submitting the nomination:
Name
First Last
Phone
Email
Date
DD slash MM slash YYYY

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