Nominator Details (Your Details)

Nominator First Name

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Nominator Last Name

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Organisation

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Position Title/Role

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Organisation Objectives*

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Nominator Email address*

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Organisation URL

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Relationship to Nominee

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Must Complete

I have read details outlined in Information for Nominations sheet

I have obtained permission from the nominee for this nomination

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How did you hear about the Award?*

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Nominee Details

Subject consent, the successful nominee's details are used in media releases and promotional material.

Nominee First Name*

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Nominee Last Name*

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Position or responsibility within the organisation where they volunteer*

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Phone

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Nominee Email address*

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1. The Work

Provide a brief description relevant to this nomination of the work or activity the nominee has undertaken and the number of years.

Describe the work or activity undertaken that is worth of recognition (250 words maximum)*

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2. The Commitment

Provide a brief description of their level of commitment and evidence outstanding service. Include details about their dedication, duration and continuity of service, and the role(s) they played in the organisation(s). If they operated as part of a team, include their contribution and any leadership responsibilities within that team.

How has commitment and service as a volunteer been demonstrated? (200 words maximum)*

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3, The Impact

Provide evidence of outcomes and positive impacts of their service to the community. Concise, practical examples demonstrating achievement should be used. Where possible, try to include quantitative evidence, such as a percentage, number or amount where relevant. Describe how they have gone above and beyond to influence change or practice. Perhaps describe how they have worked in partnership with others to bring about significant change, how they tackled obstacles to achieve desired outcomes, or how they advocated for a positive change within their community.

Outline their impact made and the exceptional qualities they have demonstrated. (600 words maximum)*

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4. Additional Information (optional)

You may provide supporting information that adds value to the nomination. Consider other outstanding achievements by the nominee, difficulties or hurdles overcome, any prior recognition of contributions, web links to awards or media coverage and any online supporting information.

Please provide any extra information that will add value to your nomination. (150 words maximum)

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Please attach any files/images or supporting information that will add value to your nomination (optional)

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The nomination form and related information will be handled in accordance with the Victorian Privacy and Data Protection Act 2014.