Hindmarsh Citizen of the Year Awards 2025 Nomination Form

Hindmarsh Citizen of the Year Awards Nomination Form

Hindmarsh Citizen of the Year awards are provided by the Australia Day Committee (Victoria) and Hindmarsh Shire Council and are presented to the successful recipients at the events that are held within Hindmarsh Shire on Australia Day each year.
Who should be nominated?
Persons who have made a noteworthy contribution during the current year and/or given outstanding service to the Hindmarsh Shire community over a number of years shall be nominated. Individuals may not nominate themselves.
Citizen of the Year Award Categories
What category would you like to nominate for? Please select one:*

2025 Hindmarsh Citizen of the Year (the person must be 25 years or older on 26 January 2025)2025 Hindmarsh Young Citizen of the Year (the person must be under 25 years on 26 January 2025)
Eligibility Check
To be eligible for this award, the nominee must meet all of the following eligibility criteria. Please select all that are true:*

This person is an Australian CitizenThey live in the municipality of Hindmarsh Shire Council (as of 26 January 2025)They have not received the same award in the last five years

Tell us about yourself
Your Full Name*

First NameLast Name
Your Address*

Street Address

Street Address Line 2

City/TownState

Post Code
Your Phone Number*
Please enter a valid phone number.
Your Email*
example@example.com
How do you know the nominee?*

FamilyFriendColleagueInvolvement in Community GroupsOther

Tell us about the person you are nominating
Nominee's Full Name*

First NameLast Name
Nominee's Address*

Street Address

Street Address Line 2

TownState

Post Code
Date of Birth*

DayMonthYear
Date of Birth
Nominee's Phone Number*
Please enter a valid phone number.
Nominee's Email*
example@example.com
Does the nominee know about this nomination?*

YesNo
How has this person made an outstanding contribution to the community?*
Any other significant contributions and/or achievements?*
Has this person volunteered in the community? If so, please tell us more about what this has involved:
How has this person made a positive impact on the Hindmarsh Community?*

Are there any other people who can be contacted to provide us further information about the nominee?

If so, please provide their details below:
Name

First NameLast Name
Relationship to nominee
Address

Street Address

Street Address Line 2

City/TownState

Post Code
Phone Number
Please enter a valid phone number.
Email
example@example.com

Hindmarsh Citizen of the Year Awards Nomination Form