2025 Australia Day Awards Nomination

2025 Australia Day Awards Nomination

Applications Due 30 November 2024
Applicant's Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Nominee's Name

First NameLast Name
Community Group/Organisation or Event Name
Name of Key Contact or Organiser*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postcode
Nominee Phone Number*
Please enter a valid phone number.
Nominee Email*
example@example.com
What is your relationship to the nominee?*
Is the nominee aware of your nomination?*

YesNo
Award category for nominee*

Citizen of the Year AwardSenior Citizen of the Year AwardYoung Citizen of the Year AwardSportsperson of the Year AwardCommunity Group of the Year AwardVolunteer of the Year AwardEvent of the Year Award
Why are you nominating this person, community group, organisation or event?*
Provide details of significant contributions or achievements that your nominee has made to the community of Yass Valley.*
For individual nominees please provide details of past or present memberships of community/sporting/professional bodies.*
Confirmation*

I confirm that the nominee is a resident, community group or organisation of Yass Valley.
Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty: