Celebrating Community Nomination Form

Shire of Mundaring
Celebrating Community 2018
Nomination Form

Shire of Mundaring is pleased to celebrate the signifcant and outstanding contribution of community members by accepting nominations for both Celebrating Community and Citizenship Awards.

Nomination Categories

Rising Star (under 25) - young people (individual or group) who have made a significant contribution to their local community.

Inspirational Volunteer - individual/group who through their volunteering role have made an outstanding contribution to the local community.

Access Mundaring - Recognises an individual or group making a difference to create a more accessible and inclusive Shire of Mundaring.

Long Service - an individual or group who have been community champions and continuously served their community for in excess of ten years.

Celebrating Community Award

Celebrate Shire of Mundaring’s inspirational community members by nominating them for the Celebrating Community awards. Nominations are invited for individuals, businesses or community groups who have made a signifcant contribution to the local community.

Shire of Mundaring will formally recognise the achievements of nominees at a celebratory event to be held on Wednesday 5 December 2018 at 6pm.

Shire of Mundaring Citizenship Award

The Shire of Mundaring Citizenship Award recognises and celebrates signifcant contributions to community life and active citizenship. Recipients will be selected from the Celebrating Community nominations and will be people who have made a noteworthy contribution during the current year, or given outstanding service to the local community over a number of years through active involvement.

Citizenship Awards will be presented at an event to be held on Australia Day, Saturday 26 January 2019.

Nominator Details

Full Name
Your Organisation Name
Phone (Home)
Phone (Work)
Phone (Mob)
Email

Eligibility Criteria

  • Nominees must not have been a recipient of an award in the past five years.
  • Sitting members of State, Federal and Local Governement are not elegible.
  • The Nominee must be an Australian Citizen.
  • The Nominee must be a resident of the Shire of Mundaring.

Nominee Details

Nomination Category *

 
Full Name *
 
Organisation
Address *
 
Phone (Home)
Phone (Work)
Phone (Mob)
Email

Referee Details

This person must be able to directly comment on the nominee’s contribution to the community.

Full Name

 
Phone (Home)
Phone (Work)
Phone (Mob)
Email

Reasons for Nomination

Please address one or more of the selection criteria below.

Positive impact on the community:
Contribution and achievements:
Demonstrated leadership/inspiring qualities:
Any other information relevant to the nomination:

If you have any relevant pictures, videos or documents to support the person's nomination, please upload them below. Ensure you have permission for any photos or videos.

Parental permission is required for persons under 18.

Highlight to select multiple files while browsing.


Any other comments?

Nominations close Monday 1 October 2018.
Please call Tracey on 9290 6678 or email ga@mundaring.wa.gov.au with any questions.




A Sense of Space, a Sense of Place. Sitemap  |   Copyright Shire of Mundaring 2018