Australia Day 2025 - Citizen and Young Citizen of the Year Awards

Candidate Details

Nomination is for *

Citizen of the YearYoung Citizen of the Year

Awards are given for the following areas. Please indicate which location they are nominated for. *

Captains FlatBraidwoodBungendoreQueanbeyan

Title

Full Name (please ensure correct spelling) *

Home Address *

Street address *

City *

State *

Postcode *

Phone number

What is the candidate's age at 26 January 2025? (This question is for the Young Citizen of the Year) *

Occupation

Have they received any other awards/former recognition?

What are their hobbies?

What sports do they play (if any)?

What type of community service have they been involved in?

Why are you nominating this person? *

Please include any other information which may strengthen this nomination

Add any attachments that support your nomination

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The candidate is nominated by

Name *

Organisation (if applicable)

Nominator Phone number *

Email Address *

I declare that the information contained in this nomination regarding the candidate is, to my knowledge, true and accurate.

Nominator signature *

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Date *

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