SHCF Young Highland Heroes Nomination Form

PLEASE NOTE:

After saving or submitting the form, you will be redirected to a Jotform login/registration page. This step must be completed to save your application. Nomination notifications will be sent from Jotform; please check your spam folder and ensure to add the email to your primary inbox for further communications.

To add a 3 minute video submission, please complete all the *required* sections of this form and upload the YouTube URL at Secton 6. Videos should include an overview of the nominee's volunteering/fundraising work including, where appropriate, the funds raised or impact that they have made. See how to upload information here.

Please read the Selection Criteria before completing this application

Application date*

Date

Name of Young Highland Hero Candidate (self nomination accepted).*

NameAge

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Organisation Details - who is the nominee supporting?*

Organisation NameABN

1. How has the nominee contributed in their own way to the betterment of an organisation or organisations and/or their services in the Southern Highlands. If submission is via video please write 'Video Submission'.*

No more than 200 words.0/200

2. If involved in fundraising, please indicate the approx. value of funds raised by the nominee.

Please give approximate amount.

3. If the nomination is successful, which not for profit organisation/s will the nominee donate the $3,000 award money and how will the funds assist them?*

Organisations eligible for the award must be registered as not-for-profit entities.

4. Has the nominee's organisation received funding from the SHCF in the last 5 years?*

5. Please upload 2 letters of support - 1 from the organisation the nominee is supporting (please include their ABN) and 1 from a referee e.g. parent, teacher, mentor who can attest to the work of the nominee.*

pdf, jpg, png

6. Insert any relevant URL links (add your 3 minute video submission if you would like to include one) to help bring the nominee and their work to life for the committee.

Url links to presentations or media supporting nomination

7. The nominated YHH agrees to be available for media and other promotional activities.*

YesNo

8. If your nomination is not successful in the round applied for, are you agreeable to this nomination being considered in the next round?*

YesNo

9. Please upload any other photographs or documentation that is relevant to your application here.

Nominator Phone Number*

Name of Nominator (self nomination accepted)*

First NameLast Name

Email*

example@example.com

Position in Organisation or community

If not self nominated

I have read and agree to the application terms and conditions.*

Yes

Authorized Signature*

Please verify that you are human*

YOUNG HIGHLANDS HEROES

Contact Details