Australia Day Award Nomination Form

Mareeba Shire Council holds the annual Australia Day Awards to celebrate and recognise the outstanding achievements of individuals and groups in the region.  These prestigious awards are presented at a ceremony that coincides with Council's Australia Day and Citizenship Ceremony.

The Judging Panel will determine awards based upon application, in order of merit. The panel will award a group, event or citizen of its choice with an Australia Day Award

Nominee Details

Referees

Please supply the names and contact details of two (2) referees who can verify the achievements of the nominee.

Referees may be contacted by Council via phone or email to either verify the nomination or for further information, if required.

Referee 1

Referee 2

Record of achievement

How did the individual / organisation / event make a significant contribution to the community (including positions held/activities undertaken)

This may include;

  • How has the nominee made an outstanding contribution to the local community?

  • What is the length of service or participation by the nominee?

  • How is the nominee an inspirational role model for the community?

  • What degree of sacrifice or difficulty has the nominee experienced in their pursuits?

  • What personal goals and objectives has the nominee achieved?

  • How has the event made a significant contribution to the community including cultural, social and economical benefits?

Nominator

Application Instructions

Please submit your nomination and any supporting documentation by 3.00pm Tuesday 6 December 2022

Email:                    info@msc.qld.gov.au

Post:                      Mareeba Shire Council, PO Box 154, QLD 4880

In Person:             65 Rankin St, Mareeba QLD 4880

For further information or assistance completing the form contact MSC Communications Team on 1300 308 461 or via email at info@msc.qld.gov.au

Declaration

I declare that the information provided by me in this nomination is true and correct and I consent to Mareeba Shire Council making additional enquiries regarding any matters relevant to this application.

Draw signature|Type signatureClear

reCAPTCHA

Collection Notice: Mareeba Shire Council is collecting your personal information in order to process your nomination. Your personal information will not be used for any other purpose and will not be disclosed to any other entity or person without your express consent or we are required by law. Your personal information will be handled in accordance with the provisions contained within the Information Privacy Act 2009 (Qld).