2023 Achievement Awards Entry Form

Achievement Awards Online Entry Form
Before commencing this form, please ensure you have (tick all to confirm and proceed):*

Completed the Assessment Criteria Document using the template provided (others may not be accepted)A brief summary statement about your nomination (100 words)Contact details of at least one referee for your nomination (up to three may be provided)Confirmed that your organisation is a Corporate Member or you are an Individual Member of IPAA WA (for a list of Corporate Members, please visit: http://www.wa.ipaa.org.au/List-of-Corporate-Member-Organisations.aspx)Details of the person who is completing the Application Declaration (this may be you or someone else). Refer to the Conditions of Entry page of the awards.Have approval from the head of your organisation to submit the nomination (If nominating as an IPAA WA Corporate Member)
Please Enter Details of the Primary Contact for this Nomination

This is not the person you are nominating, but it is the person we will be in contact with regarding this nomination.
Full Name*

TitleFirst NameLast NamePost-nominal
Position*
Organisation*
Phone Number*
Email*
Postal Address*

Street / PO Box

Street Address Line 2

SuburbState

Postcode

Achievement Awards Online Entry Form
Please enter the details of the person you are nominating.
Double check the details below are correct, as these details will appear on trophies (if successful) and all other Awards' related material.
Full Name (Nominee)*

TitleFirst NameLast NamePost-nominal
Position (Nominee)*
Organisation (Nominee)*
Postal Address (Nominee)*

Street / PO Box

Street Address Line 2

SuburbState

Postcode
Phone Number*
Email*
Please enter the details of the Organisation and Project/Initiative you are nominating.

Double check the details below are correct, as these details will appear on trophies (if successful) and all other Awards' related material.
Organisation/s (It is the nominator's responsibility to ensure all organisations' names are being recognised appropriately).*
List the main organisation/s who you would like acknowledged officially if successful (e.g. on trophies, at the presentation ceremony, and on all other official Awards' material)
Project/initiative name*
Postal Address

Street / PO Box

Street Address Line 2

SuburbState

Postcode
Is the lead organisation entered in the field above (i.e. the first organisation to be recognised at the awards) a subsidiary or part of a larger organisation? E.g. a division of a government department, a school within the Department of Education, a division of a larger organisation, etc.*

YesNo
What is the name of the governing organisation?*
Please confirm this is how the governing organisation wants all contributing organisation/s to be recognised at the Awards:*

Attach Assessment Criteria Document here*
Important: Only the official Award Assessment Criteria Word Document available to download from your chosen Award Category page will be accepted. You may convert this document to a PDF if you wish.

Achievement Awards Online Entry Form

Please Enter Details of the Primary Contact for this Nomination

Achievement Awards Online Entry Form

Achievement Awards Online Entry Form

Achievement Awards Online Entry Form

Terms and Conditions

Application Declaration