Impact Awards Nomination

Impact Awards Nomination
This form accepts nominations for the DiabetesVictoria Impact Awards, including the Outstanding Contribution Award,Outstanding Contribution – Lived Experience Award, Peer Support Award, DiabetesCamps Victoria Award, and Prevention Leader Award.

Learn more about the awards here.
Title
Your Name
Your Email
Phone Number
Format: 0000000000.
Postal Address

Street Address

Street Address Line 2

CityState

Postcode
Your current position
Which award are you nominating for?
Online Submission ID
- Honouring individuals who have made substantial and meaningful contributions to improving the lives of Victorians affected by, or at risk of, diabetes.
  
  View the criteria.
- Outstanding Contribution Award
- Your relationship to the nominee
- Do they know about the nomination?
- Nominee Title
- Name of nominee
- Nominee Email
- Nominee Phone Number
  Format: 0000000000.
- Current position
- Nominee Postal Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Postcode
- Why Are You Nominating This Person?
  
  Please upload your document for review. Must be 300 words or less.
  Cancelof
- Upload a photo of your nominee (optional)
  
  Cancelof
- Celebrating a Victorian living with diabetes, or caring for someone living with diabetes, who has made a meaningful contribution over time to support others in the community.
- Outstanding Contribution Award - Lived Experience
- Your relationship to the nominee
- Do they know about the nomination?
- Nominee Title
- Name of nominee
- Nominee Email
- Nominee Phone Number
  Format: 0000000000.
- Current position
- Nominee Postal Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Postcode
- Why Are You Nominating This Person
  
  Please upload your document for review. Must be 300 words or less.
  Cancelof
- Upload a photo of your nominee (optional)
  
  Cancelof
- Recognising those who provide invaluable time, care, and ideas to help others feel supported and included within peer support groups.
- Peer Support Award
- Your relationship to the nominee
- Do they know about the nomination?
- Nominee Title
- Name of nominee
- Nominee Email
- Nominee Phone Number
  Format: 0000000000.
- Current position
- Peer Support Group (if known)
- How long have they been involved in the group? (If known)
- In what capacity are they involved in the group?
- Nominee Postal Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Postcode
- Why Are You Nominating This Person
  
  Please upload your document for review. Must be 300 words or less.
  Cancelof
- Upload a photo of your nominee (optional)
  
  Cancelof
- Acknowledging the significant difference made by Diabetes Camps Victoria volunteers and health professionals in supporting children and adolescents living with type 1 diabetes, and their families.
- Camps Award
- Your relationship to the nominee
- Do they know about the nomination?
- Nominee Title
- Name of nominee
- Nominee Email
- Nominee Phone Number
  Format: 0000000000.
- Current position
- In what capacity are they involved?
- How long have they been involved in the camps program? (If known)
- How many camps have they attended? (If known)
- Nominee Postal Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Postcode
- Why Are You Nominating This Person
  
  Please upload your document for review. Must be 300 words or less.
  Cancelof
- Upload a photo of your nominee (optional)
  
  Cancelof
- Celebrating community members who demonstrate exceptional dedication to preventing type 2 diabetes and improving community health outcomes through inclusive, innovative, and community-driven initiatives.
- Prevention Leader Award
- Your relationship to the nominee
- Do they know about the nomination?
- Nominee Title
- Name of nominee
- Nominee Email
- Nominee Phone Number
  Format: 0000000000.
- Current position
- Nominee Postal Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Postcode
- Why Are You Nominating This Person
  
  Please upload your document for review. Must be 300 words or less.
  Cancelof
- Upload a photo of your nominee (optional)
  
  Cancelof
- Should be Empty: