Australia Day Award Nomination Form

  • Nomination forms must be returned by 5pm Friday 2 November, 5pm. Selection of the winners will be made by a community panel and the presentation of the awards will be made on Australia Day, Saturday 26 January 2019.

  • Nomination details

  • Your Details

  • Nomination Referee

    Who also supports this nomination? A second person is required to support this nomination
  • Selection Criteria

    Please let us know how the individual has met each of the selection criteria.
  • Drop files here or
    Please feel free to attach additional materials such as photos, newspaper articles or other documentation to support this nomination. Note that these items will not be returned. All nominations will be kept confidential.
  • Agreement