AUSTRALIA DAY AWARDS

Australia Day Awards 2025

NOMINATION FORM

Leeton Shire’s Australia Day Awards honour individuals and groups who have made a positive impact in our community.

Residents of the Leeton Shire Local Government Area are invited to nominate deserving community members for these awards. Nominations will be reviewed based on the details provided in this form, so please include accurate and complete information about the nominee.
I would like to nominate...*

First NameLast Name
Address
Phone Number*
E-mail*
Nominated Category*

Citizen of the YearYoung Citizen of the YearLifelong Citizen of the ShireGroup/Organisation/Event of the YearSportsperson of the YearJunior Sportsperson of the YearAchiever of the YearYoung Achiever of the Year
REASON FOR NOMINATION:
Why do you believe this nominee deserves an award?
Please describe their contributions or achievements, including the names of any groups, clubs, or committees they’re involved in. Include details of their community service, such as working with local charities, length of involvement, and frequency of their service.
How has the nominee inspired others in the Leeton community?
Describe any challenges they've overcome, ways they’ve gone above and beyond in their role, and their positive impact on others.
How has the nominee’s work or actions positively impacted our community?
Provide examples of the contributions they’ve made and the difference these have brought to others.
What makes this nominee a valued member of the Leeton community?
Include their involvement, interests, and any personal qualities that make them a role model.
Other Contributions or Achievements:
Include relevant memberships, awards, and higher-level achievements (e.g., regional or state representation).
Additional Information (optional):
Share anything else that strengthens the nomination.
Supporting documentation (if required):

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Your Details:
Full Name*

First NameLast Name
Address
Phone Number*
E-mail*
example@example.com
MORE INFORMATION

NOMINATIONS CLOSE 5pm Wednesday 8th January 2025 For further enquiries please phone Leigh Houghton on 6951 3111 or Fran Macdonald on 6951 3103 (Wed to Fri) or email events@leeton.nsw.gov.au
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REASON FOR NOMINATION:

MORE INFORMATION