Nomination Form
The NatStats Board, along with the Australian Bureau of Statistics (ABS) invites you to apply for the NatStats 2013
Conference Awards. These awards recognise excellence in using administrative data, developing statistical capability
and using statistics in the media. Entries are invited from individuals and teams, in both the private and public sectors.
Nominations can be made directly, or individuals and organisations can be nominated by a third party.
Please complete the following details and return with your entry addressing the selection criteria by 5.00pm Friday 22
February 2013.
Nominee (team leader)
Entry Category (one category per form)
Full name
Position Title
Address
Phone
Mobile
Email
Nomination details (if not self nominating)
Full name
Position Title
Address
Phone
Mobile
If entering in a team award, please list all team members names
Selection Criteria (maximum of 200 words per criteria)
Criteria 1
Criteria 2
Criteria 3
Criteria 4
Email
Nominee endorsement (to be completed for all nominations)
I have read the terms and conditions of entry and agree to abide by them. I accept the judges’ decision is final. I have
completed the nomination form and addressed the selection criteria. I agree to the nomination being placed on the
NatStats 2013 website and the ABS consulted in any immediate publicity opportunities arising from receipt of the
award.
I certify that the information provided is true and correct to the best of my knowledge.
Note: If submitting by email, please ensure the Nominee’s name and the date are included.
Name
Date
Signature
Saving and submitting your nomination

Saving the form: You can save this form as you would a normal file, and then submit it at a later date.

Submit by email: Choose: File – Send to – Mail recipient (as Attachment). This will allow you to include other
files with your Nomination Form. natstats@nss.gov.au
 Print your form: You may print the form and submit a hard copy to:
Tanya Hornick
ABS Office
GPO Box 9817
Brisbane 4001

Please remember to submit a copy of the nominee’s current Curriculum Vitae (maximum 5 pages) highlighting
key achievements, high impact work and publications. Team nominees can supply abbreviated versions of
their team members’ curricula vitae.
Office use only
Number
Date received