Online Form - Australia Day Citizen Awards Nominations for the 2024 Australia Day Awards are Now Open There are so many fantastic people in our community - now is the time to nominate them and let them shine on Australia Day! The following Award categories are available for nomination: Citizen of the Year (must be a resident or member of CV community group in the Shire of Chapman Valley) Young Achiever of the Year (must be a resident or member of CV community group in the Shire of Chapman Valley and under 25 years of age on 26 January 2024) Community Group or Event of the Year (If community group: majority of members of the nominated group must be residents or members of CV community group in the Shire of Chapman Valley. Hardcopy forms are available at the Nabawa Shire Office. If you have any questions, please contact the Shire on on 9920 5011. Nominations close at 4pm, Friday November 17, 2023. Nominee, Full Name or Group (individual or group to receive award)* * Required Field. Nominee, Address* * Required Field. Nominee, Contact number* * Required Field. Nominee, Email Address* * Required Field.* Please enter a valid email address Nomination Category* Citizen of the Year (must be a resident or member of CV community group in the Shire of Chapman Valley) Young Achiever of the Year (must be a resident or member of CV community group in the Shire of Chapman Valley and under 25 years of age on 26 January 2024) Community Group or Event of the Year (majority of members of the nominated group must be residents or members of CV community group in the Shire of Chapman Valley) Is this person being renominated for an Australia Day Award? If yes, please state which year the original nomination occurred. YesNo If yes, please detail: Reason for Nomination (Suggestions to include: information about who in the community is benefiting from this great work, events held, funding raised, involvement in the community)* * Required Field. Please outline the nominees (individual or group) achievements in the last 12months Has the nominee (individual or group) engaged with other community organisations in the past 12months? If yes, please outline details. YesNo If yes, please detail: Why is this nomination important to Chapman Valley? Referee Full Name 1* * Required Field. Referee Full Name 2 Nominator, Full Name:* * Required Field. Nominator, Relationship to Nominee:* * Required Field. Nominator, Residential Address Nominator, Contact number* * Required Field. Nominator, Email Address* * Required Field.* Please enter a valid email address Declaration, By submitting this form I:* Support this 2024 nomination and confirm that the details provided about the nominee are correct to the best of my knowledge; Would be happy to be contacted by the Shire of Chapman Valley to provide further information and verification if required. Type the code from the image: Do not fill this textbox.