Wagga Wagga Local Achievement Awards nomination form

Required fields are marked with an asterisk (*).
Section A: Nominator
Section B: Award Category
Please tick one award category
Section C - Part One: Nominee
Are you nominating yourself? *
Section C - Part Two: Nominee
Section D: Summary of Achievements

Please outline in up to 500 words your achievements if you are nominating yourself or the person you are nominating. Consider the evaluation criteria outlined for each particular award category.

Attach any additional information [limit of four A4 pages] to your nomination. This may include newspaper articles, personal reference and/or a resume.

(limit of four A4 pages)

Section E: Referee

Person who is able to make a direct comment of the contribution/service of the person you are nominating.

Section F: Nominee Declaration

Please enter initials

I have read and understood the terms and conditions of entry, and consent to being nominated. *

PRIVACY

The personal information provided in this document is protected under the Privacy and Personal Information Protection Act (PPIPA) 1998. The PPIPA provides for the protection of personal information, and for the privacy of individuals. Wagga Wagga City Council will not disclose your personal information to any person or body unless required by law to do so or if it is directly related to the purpose for which the information was collected.

DEADLINE

Nominations must be received by 5pm Monday 3 February 2020. No late submissions will be considered.