NOMINATION FORM
Please note: nominations close 5pm on Sunday 22 September 2024
ELIGIBILITY AND CATEGORIES OF AWARDS
Your details (nominator)
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you happy to be identified as the nominator?
YES/NO
Nominee details
Volunteer information
Preferred Title/Pronouns (if applicable)
TITLE eg. DR, Mr, Mrs, Ms, Miss
PRONOUNS - He/His, Her/She, They/Them
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list the organisation/s the Nominee volunteers for:
List as many as relevant
Has this nominee/s been a previous recipient of these awards?
YES/NO
CATEGORY FOR NOMINATION
Youth (under 24 years)
Emergency Management
Group
Inspiring Individual
Member of Parliament
How did you hear about the Wannon Volunteer Awards?
Please Select
Previous award winner
Email
Social Media
Newspaper/Radio
Word of mouth
Other
REASON FOR NOMINATION
In approx. 100 words, please describe why you nominated this person/team/organisation
KEY ACHIEVEMENTS OF THE NOMINEE
Eg. Fundraising figure, roles held and timeframes, other notable recognitions, volunteering history
KEY ATTRIBUTES OF THE NOMINEE
Eg. Leadership, commitment - please refer to the elibility criteria
YEARS OF SERVICE
Submit
Should be Empty: