Citizen of the Year Awards

Award Category

First Name

Last Name

Address

Date of Birth

Telephone

Is the person being nominated an Australian Citizen?

Reason for nomination

How has the person/organisation contributed to the community?

How has the nominee demonstrated active citizenship and enhancement of community life?

Please list any other significant contributions and/or achievements:

How has the nominee's contribution been recognised elsewhere?

Please provide the contact details of a referee or attach a written reference

First Name

Last Name

Telephone

Occupation

What is the referee's relationship to the nominee?

What can the referee comment on?

First Name

Last Name

Address

Telephone

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