Introduction
Navigate through the different form sections using the navigation on the left, or use the next/previous buttons located at the bottom of each step.
Save Your Progress
You have the ability to save this form and complete it at a later date. An email will be generated and sent to the specified address.
Note: Incomplete forms are kept for a period of 7 day(s), after this time the system will automatically delete your response.
Nomination Details (one per application)
Collection Notice
The Shire of Wongan-Ballidu is committed to protecting your privacy.
The personal information you provide in this Citizenship Awards Nomination Form is collected for the purpose of assessing and administering nominations for the Shire's Community Service Awards, verifying eligibility, contacting nominees and nominators where required, preparing award presentations, and meeting the Shire's legal and administrative obligations. This information is collected under the Local Government Act 1995 (WA) and any other applicable legislation.
If a nomination is successful, the nominee's name, award category and information provided in the nomination may be used by the Shire for recognition and promotional purposes, including publication on the Shire's website, social media channels, newsletters and other communication materials.
Your personal information will only be used or disclosed for the purpose for which it was collected, or where authorised or required by law. The Shire may share your information with members of the Community Service Awards Selection Panel, government agencies or other organisations where necessary to assess nominations or fulfil its statutory obligations.
Providing the requested information is voluntary; however, if sufficient information is not provided, the Shire may be unable to assess or consider the nomination.
You may request access to, or correction of, your personal information held by the Shire by contacting the Shire.
For more information about how the Shire manages personal information, please refer to the Shire of Wongan-Ballidu's Privacy Policy or contact the Shire on (08) 9671 2500 or email shire@wongan.wa.gov.au.