Brimbank Australia Day Awards 2016
CITIZEN OF THE YEAR AWARD
Nomination Pack
GUIDELINES AND NOMINATION FORM
Brimbank City Council invites nominations for citizens who will be recognised for their
outstanding efforts and contributions to the community as part of Brimbank’s Australia
Day Celebrations. The winner will be announced at a formal ceremony on Monday 18
January 2016.
Brimbank Citizen of the Year Award - Criteria

Selection for this Award will be made on the basis of service to the Brimbank
community in any field considered appropriate by the Selection Panel: examples are
community service, conservation, culture, education, environment, cultural diversity,
visual and/or performing arts and may also take into account acts of compassions,
generosity or bravery.

Nominees must either reside OR do business in the Brimbank City Council Local
Government Area.

Nominations MUST be accompanied by a biography or CV of the nominee.

Nominees MUST be aged 26 years or over as at 26 January 2016 AND be an
Australian Citizen as at close of nominations on 27 November 2015.
Please note: Only individuals may be nominated for Citizen of the Year. Candidates
who have been unsuccessful in previous years may again be nominated. Candidates may
be invited to interview.
Submissions Checklist
Please read the guidelines, general conditions of entry and criteria prior to completing
the Nomination Form. Submissions may be emailed or posted and must include:
Completed Nomination Form
Biography or CV of the nominee
Completed and signed acceptance of the nominee
Completed and signed agreements of the nominator and referee
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(Optional) Copies of documents that support this nomination and provide official
recognition of the nominee such as newspaper articles, letters of support,
certificates of achievement, awards etc. Please note that these documents will not be
returned, retain a copy for your records
Nominations must be received by 5pm Friday 27 November 2015
Nominations received after 5pm on Friday 27 November 2015 will be ineligible for
consideration.
Please note:
 Candidates may be invited to an interview with selection panel
 Candidates must be available to attend the Brimbank Australia Day
Awards presentation ceremony on Monday 18 January 2016
 Nominators may be contacted by Council prior to the judging process
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Who are you nominating?
DETAILS OF NOMINEE:
Mr / Mrs / Miss / Ms / Dr:
First name
Surname
Residential Address:
Postal Address:
Telephone: [h]
[w]
[m]
Email:
Date of Birth:
Role and organisation:
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1. Why are you nominating this person as Brimbank Citizen of the Year?
2. What does the nominee do in the community? Describe the nominee’s past and/or
present community involvement:
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3. How has the nominee made an outstanding contribution to the local community?
4. Can you describe any personal challenges experienced or overcome in their pursuit of
community service?
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5. Who in the community has benefited from the work and/or contribution by the
nominee?
6. What is special about the nominee that inspires other members of our community to
look to the person as a role model?
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7. Additional information: Please note any additional information you feel that may
assist in the judging of your candidate. (Please also include or attach any other
supporting documents and CV or Bio)
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Who is making this nomination?
DETAILS OF NOMINATOR:
Mr / Mrs / Miss / Ms / Dr:
First name
Surname
How do you know the nominee?
Your Role & Organisation (if applicable):
Postal Address:
Telephone: [h]
[w]
[m]
Email:
I declare that the information contained in this nomination regarding the candidate is to
my knowledge true and accurate and in accordance with the General Conditions of Entry.
I agree to be contacted by Council prior to the judging process, if required.
Signed:
Date:
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Who supports this nomination?
NOMINATION SUPPORTED BY [Referee]:
Mr / Mrs / Miss / Ms / Dr:
First name
Surname
How do you know the nominee?
Your Role & Organisation (if applicable):
Postal Address:
Telephone: [h]
[w]
[m]
Email:
I declare that the information contained in this nomination regarding the candidate is to
my knowledge true and accurate and in accordance with the General Conditions of Entry.
Signed:
Date:
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AGREEMENT OF CANDIDATE:
This section is a pre-requisite for your nomination
I hereby accept nomination for the ‘Brimbank Citizen of the Year Australia Day Award’
and confirm that the information contained in this nomination form is correct and that all
important and relevant information is included.
[please tick the boxes]
I declare that I am an Australian Citizen and have provided a photocopy of my
passport, birth certificate or Australian Citizenship document [all information supplied will
be protected under the Information Privacy Act 2000]
I am willing to attend the Australia Day Awards presentation ceremony* to be
held on Monday 18 January 2016.
I am willing to be a guest of Brimbank City Council at the Australia Day Citizenship
Ceremony at 10am on Tuesday 26 January 2016 at the Kevin Wheelahan
Gardens, Devonshire Road, Sunshine.
I am willing to be interviewed by the selection panel, at a date to be advised (if
required).
I agree to allow my nomination details to be available for media promotion. I
understand that I will be required to have my photograph taken for media promotion and
that I may be required to sign a release for that purpose in that Brimbank City Council
may use my photograph and any other information or materials submitted in its
promotion of the Brimbank Australia Day Awards.
Signed:
Date:
*It is a condition of nomination that if you are successful with your nomination you must make
yourself available to attend the Australia Day Awards presentation function.
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NOMINATIONS to be EMAILED to australiaday@brimbank.vic.gov.au or POSTED and
marked:
‘CONFIDENTIAL’ to:
Australia Day Awards
Media and Communications
PO Box 70
SUNSHINE VIC 3020
FOR ADDITIONAL INFORMATION CONTACT:
Media and Communications, Civic Events and Engagement Coordinator
Brimbank City Council
Telephone: 03 9249 4000
Email: australiaday@brimbank.vic.gov.au
Web:
www.brimbank.vic.gov.au
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