Nomination Form
Nominator Information:
Name
First Name
Last Name
Email
example@example.com
Organisation
example@example.com
Job title
Phone Number
Please enter a valid phone number.
Nominee Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Organisation
Job title
Category being nominated for:
Nomination Details:
Please address each of the following criteria in detail. Where possible, quantify achievements and provide specific examples. You may attach additional supporting documents (maximum 5 pages). Word limits are suggestions. Please be comprehensive but concise.
Achievement(Suggested Word Limit: 300 words)
How award-worthy has this candidate been within their field, commensurate with experience? Provide a top-level assessment of the overarching strength of the application.
Impact (Suggested Word Limit: 300 words)
Describe the nominee's impact within their field and more broadly. Include both traditional and non-traditional measures. Proven Profile: Does the candidate have a proven profile, commensurate with experience? Outreach: Detail the bigger picture of this candidate’s contribution and the extent to which they have demonstrated a commitment to wider community engagement. Leadership: Describe the candidate’s ability to inspire and mentor others.
Evidence (Suggested Word Limit: 300 words)
Describe the strength of supporting materials for the application, including references and testimonials. What is the peer support for this candidate? Detail the strength of training and qualification credentials.
Innovation (Suggested Word Limit: 300 words)
How has the nominee contributed to the advancement of knowledge or practice, with scope for creativity and individual or collective contribution? How novel is this application/achievement compared with the pool of applicants? Is the candidate a visionary or trailblazer?
Quality (Suggested Word Limit: 300 words)
Describe the nominee's quality of care and demonstrated commitment to standards and safety. To what extent have evidence-driven outcomes been demonstrated and applied?
Fit (Suggested Word Limit: 300 words)
Explain the nominee's fit with the category and the awards, and the profile of the sector. To what extent would the sector benefit through championing this candidate?
Supporting Documents Please list any supporting documents attached (maximum 5 pages):
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References Please provide contact information for two references who can speak to the nominee's qualifications and achievements.
By submitting this nomination, I confirm that the information provided is accurate and complete to the best of my knowledge.
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Date
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