Victorian School Sports Awards - Lindsay Gaze Award

STUDENT INFORMATION
Sport*
Other
If you selected 'Other' from the dropdown list please add the full name of in this box.
Full Name*

First NameLast Name
Date of birth*

MonthDayYear
Gender*

MaleFemale
Year Level*
Please select the grade of the student, for the year of nomination
SCHOOL INFORMATION
School Name*
Please write the full name not the abbreviation
Principal's Name*

First NameLast Name
Principal's Email*
example@example.com
School Address

Street Address

Street Address Line 2

CityPost Code

Postal / Zip Code
School Phone Number*

Area CodePhone Number
Nominee's Sporting Achievements

Please list the sporting achievements for the nominee in the past 12 months.
Contribution to School Sport*
Describe what contributions the nominee has made to community sport
Contribution to Community Sport*
Describe what contributions the nominee has made to school sport
NOMINEE CITATION

Should the nominee be selected for the award, this citation may be read at the Sports Awards function, so please ensure information is precise and accurate. This citation should summarise the nominee’s achievements. Please use a maximum of 100 words.
Maximum 100 words*

0/100
SPORTING ORGANISATION

Please add the name and contact details of the State or National Sporting Organisation, they will receive an email to endorse the achievements.
Organisation Name*
Name*

First NameLast Name
Email*
example@example.com

Person Making the Nomination
Name

First NameLast Name
Email
example@example.com
Position held
I agree to the nominee being photographed or filmed for the Victorian School Sports Awards for publicity purposes, according to the SSV Privacy Policy.
Signature (Please use your mouse of finger to sign the white panel)

Thank you for your submission. Good luck with your nomination.

Please click submit to finish your nomination.

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LINDSAY GAZE AWARD