Homegrown Heroes Community Awards Nomination

Homegrown Heroes Community Awards Nomination - Meritorious Service Award
Any personal information collected by the Shire of Harvey will only be used for the purpose for which it has been collected, or for a purpose you would reasonably expect in carrying out the Shire’s activities and functions. Your information may also be used for ongoing research and development of our services. Read more on the Shire of Harvey website: Home / Privacy Policy.
Nominee Details
Name of Nominee*

First NameLast Name
Address of Nominee*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number of Nominee
Please enter a valid phone number
Email address of Nominee
If known
Your Details
Nominator Name*

First NameLast Name
Address of Nominator*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number of Nominator*
Please enter a valid phone number
Email address of Nominator
If you have one
Is the nominee aware of this nomination?
Selection Criteria
How long has the Nominee been a resident in the Shire of Harvey?*
If not a resident, please answer the next question
How long has the Nominee been serving the residents in the Shire of Harvey?*
Only answer this question if the nominee resides outside of the Shire of Harvey BUT their meritorious service has been within, and benefited the residents of, the Shire of Harvey
What are the Nominee's achievements?*
Describe any important achievements that the Nominee has been responsible for, or made a significant contribution to, whilst serving the community.
In what ways have this Nominee's actions or service created positive outcomes or meaningful benefits for the community?*
If the Nominee has received previous awards, could you please provide a list of the awards bestowed?
Please limit this to a maximum of 10 years history.
Please upload any supporting documentation

Cancelof
There will be multiple recipients of the Appreciation Award, however there can be only one Meritorious Award winner. Should your Nominee not be considered/successful for the Meritorious Award, would you like them to be considered under the Appreciation Award category?

Yes, please place for consideration under the Appreciation Award categoryNo, only consider under the Meritorious Award category
Confirmation
I declare that all the above statements and attached supporting information are true to the best of my knowledge.*

I agree
Please verify that you are human*
Should be Empty:

Homegrown Heroes Community Awards Nomination - Meritorious Service Award