Online Form - Citizenship Awards Nomination Form

Nominations are now OPEN for 2024 Community Service Awards. Nominations should be received no later than 4:00pm on Friday 1st December 2023.

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Category of Nomination (please tick one per application)*

Citizen of the YearYoung Citizen of the YearCommunity Event of the YearCommunity Group of the Year

Community Event or Community Group Name (if applicable)

Full Name of Nominee (or main contact person if on behalf of a group or event)*

Nominee's Home Address*

Nominee's Contact Number*

Nominee's Date of Birth*

Reasons for the nomination*

Details of Periods of Service within the Community. E.g. Served 12 years as a Shire Councillor, served 6 years as President of a particular club.*

Other Supporting Information

Have you made this nomination as:*

An IndividualOn Behalf of a Group

Your Name*

Your Address*

Your Contact Number*

Your Email Address