Nomination Form

Australian of the Year Awards 2011

Commonwealth Bank - Major Sponsor

Nominate an Australian citizen in one or more of the following categories:

Note: All nominee's are automatically eligible for the Australian of the Year Award and the Australia's Local Hero Award.

Nominee

(The person you'd like to nominate)

Details
Address
Contact Details

At least one phone number is mandatory *

Area of Excellence

In what area(s) has the nominee excelled? Please tick the relevant boxes below:

Tell us about your nominee

How are they an inspirational role model? How have they demonstrated excellence in their field and to the community?

Supporting Documents/Files

We encourage you to include supporting documentation with your nomination. Supporting documents can include personal references, resumes, newspaper articles, etc. Your aim is for the selection panel to understand why you think your nominee should be selected. Note: all documentation will be retained by the National Australia Day Council.

If you're unable to upload it here, please post it to:

National Australia Day Council
Old Parliament House
King George Terrace
Parkes ACT 2600

or email it to awardsinfo@australiaday.org.au Please quote your reference number on all materials.

Please do not upload material larger than 5MB.

Nominator

(Your Details)

Details
Address
Contact Details

At least one phone number is mandatory *

How did you hear about the Australian of the Year Awards? *

Referee

(optional - this will help us if your nominee is shortlisted. This person may be contacted for further information.)

Details
Address
Contact Details

At least one phone number is mandatory *

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