Australia Day Nomination Form

Each year Coolamon Shire celebrates Australia Day with an official ceremony at which the Shire’s Australia Day Awards are announced. The awards are an integral part of these celebrations, recognizing the hard work and dedication of local people who typify the Aussie spirit. To be eligible for an award, individuals must reside in the Coolamon Shire.

If you wish to nominate someone that you feel deserves public recognition for their achievements and contributions to the community, please complete this nomination form.

Nominations close Wednesday 3 December 2025.

Nominator Name*

Nominator Phone *

Nominator Address*

Nominator Email*

Nominee Name*

Nominee Address*

Nominee Phone

Nominee Email

I nominate the above mentioned in the following category (please tick):

Category:*

Citizen of the Year Award: A person over 25 years of age, who has made a valuable contribution to the Community, either during the previous 12 months or over many years of service.Young Citizen of the Year: A person aged 25 years or less, who has made a valuable contribution to the Community, either during the previous 12 months or over a number of years.Shane Till Memorial Award for Sporting Achievement: A person who has achieved an outstanding performance (as a participant or administrator) in the field of sport, either during the previous 12 months or over a number of years.Young Sportsperson of the Year Award: A person aged 25 years or less, who has achieved an outstanding performance (as a participant or administrator) in the field of sport, either during the previous 12 months or over a number of yearsCommunity Event / Community Group of the Year: an event that attracts broad / large community support and/or external visitation. A community group may be a Club, Committee or Organisation that either organises a particular one-off event that has a significant purpose within the Coolamon Shire or alternatively a Club, Organisation or Committee that has a record of significant achievement to the Community over many years.

Please provide a clear and detailed description outlining the reasons for your nomination.

Please also ensure the information you provide is accurate as your nomination will be printed in the event program.

You may wish to include things such as: Volunteer work carried out within the community; General contributions to the community; Executive positions held on any committees; Sporting awards and achievements.

Please provide a clear and detailed description outlining the reasons for your nomination. *

Is this person aware that they have been nominated?*

YesNo

Award winners will be determined at the December 2025 Council meeting.

If you are having any issues with this form, please contact Molly Campbell Council's Community Engagement Officer on 69272492 or mcampbell@coolamon.nsw.gov.au

Australia Day Nomination Form

NOMINATOR INFORMATION

NOMINEE INFORMATION