Australia Day 2026 - Citizen, Young Citizen and Senior Citizen of the Year Awards

Section 1 - Nominee Details

Nominee Name (first and last name) of the person you are nominating. Please ensure correct spelling. *

Home Address

Street address

Suburb/locality

State

Postcode

Phone number

Email

Occupation

Nomination is for *

Young Citizen of the Year (ages 16-30)Citizen of the Year (ages 31-65)Senior Citizen of the Year (ages 65+)

Awards are given for the following towns and their surrounding areas. Please indicate which location they are nominated for. *

Captains FlatBraidwoodBungendoreQueanbeyan

Section 2 - Nominator and Seconder Details

The candidate is nominated by

Full name (first and last name) *

Organisation (if applicable)

Nominator address *

Street address *

Suburb/locality *

State *

Postcode *

Nominator Phone number *

Nominator email address *

What is the nominator's relationship to the nominee? *

Nominator signature *

Draw signature|Type signatureClear

Date *

Please provide details of a seconder for this nomination who we can contact to verify the nomination.

Full name of seconder *

Seconder Organisation (if applicable)

Seconder phone number *

Seconder email address *

What is the seconder's relationship to the nominee?

Section 3 - Reasons for nomination

Please refer to Eligibility and Selection Criteria in section 4 to ensure Nominee eligibility.

To make your nomination as strong as possible, we suggest you include more information than you think. Consider these points.

How does the nominee model integrity, respect, innovation and continuous improvement in the community?
What qualities, individual acts of compassion, generosity, bravery, and consistency make this nominee a deserving recipient of this award?

Why is this person worthy of being nominated for this award? *Summarise the reasons why your nominee should be considered. Consider: What is the key information about this nomination that you want the committee to know? What else are they involved in? Please note that this text may be used in the selection process and used for promotional purposes.

Please use some examples to demonstrate their outstanding achievements and how they have contributed to our community in the last 12 months: *Minimum 100 words. What has the nominee done above and beyond? When/where? Why this year?

Please provide some background information about your nominee. *Minimum 100 words. Consider including previous awards received, history and length of service, and whether the work/service was paid or voluntary, etc.

Provide any documents/attachments that support your nomination

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Recommended but not essential – Max 4 attachments. Suggested information to provide with your application includes anything which may strengthen the nomination e.g. copies of certificates, awards, photos, newspaper clippings, letters, sporting involvements or achievements, etc.

Section 4 - Eligibility

A person who has won an Australia Day Award in the past is not eligible to be considered for nomination in the same category again. For example, a Citizen of the Year cannot receive the Citizen of the Year award again. Nominees for Australia Day Awards must be Australian Citizens. The Australia Day Award Committee and QPRC takes into consideration that the nominee may have had to leave the LGA to undertake the activities that have led to the nomination.

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

*

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