Citizen of the Year Nomination

Required fields are marked with an asterisk (*).

Nomination

Citizen of the Year Nomination * The Citizen of the Year Awards are proudly presented by the Australia Day Council of South Australia, sponsored by LGA South Australia, Sarah Constructions, MGA Insurance, Community Bridging Services Inc., Community Business Bureau and Flinders University. These awards acknowledge the unsung heroes of our community who through their contributions make our state a better place. These individuals and organisations offer outstanding service each day and enable our communities to be stronger as a result of their tireless efforts. Outstanding contribution and community service includes areas such as education, health, fundraising, charitable and voluntary services, business, sport, arts, the environment, or any other area that contributes to the advancement and well being of a community. Nominate someone who makes a real difference in your community and give them the opportunity to be celebrated and recognised for their important contribution.

Citizen
Young Citizen
Event of the Year
Building a Better Community

Nominee (the person/organisation you would like to nominate)

Name *

Address

Phone *

Date of Birth

Council Area

Is the person being nominated an Australia Citizen?

Yes
No
Unsure

Reason for Nomination

Why do you believe this person/organisation should be nominated for an Award? *

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

Has the person/group overcome any particular challenges, personal sacrifices or adversities to mark their achievement? *

How has the nominee's contribution been recognised elsewhere? *

Please attach any additional material.

Referee (please provide the contact details of a referee or attach a written reference)

Name *

Contact Number *

Email Address *

Occupation

What is the referee's relationship to the nominee? *

What can the referee comment on?

Nominator (your details)

Name *

Contact Number *

Email Address *

I give permission for Berri Barmera Council to submit this nomination to other recognition programs such as the Australian of the Year Awards