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

Section 1 - Nominee Details

Full 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 areas. Please indicate which location they are nominated for. *

Captains FlatBraidwoodBungendoreQueanbeyan

Section 2 - Nominator and Seconder Details

The candidate is nominated by

Full 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 *

Section 3 - Reasons for nomination

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

Why is this person worthy of being nominated for this award? *In 150-200 words, summarise the reasons why your nominee should be considered. 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: *Not to exceed 150 words. What has the nominee done above and beyond? When/where?

Please provide some background information about your nominee. *Not to exceed 150 words. Examples may include previous awards received, history and length of service, indication if 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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