nomination form Seniors Awards 2013 - Townsville City Council

nomination formSeniorsAwards 2013Recognising seniors for their achievementsand contributions to our communitywww.townsville.qld.gov.aupage 1

nomination formSeniors Awards 2013how to nominate a volunteer >>The Townsville City Council Seniors Awardsare open to people aged over 60 who havevoluntarily given their time for the good of theTownsville Community.The volunteer activities must have occurredwithin the city of Townsville.To nominate a volunteer, please write between300 and 600 words addressing the selectioncriteria. You can use the dot points providedunder each criteria as a guide. Your nominationshould be a total of about one page of typed,single spaced writing, or two full handwrittenpages. Please type or write your responseon a separate sheet/s of paper attach to thenomination form.eligibility >>>> You can nominate any permanent residentof Townsville aged 60 years or over as at 31July 2013>> You can not nominate yourself.important notes >>The Townsville City Council selection committee isunable to consider nominations that do not meetthe following:1. The nominated person must be 60 years ofage or over as at 31 July 2013.2. The activities for which they are beingnominated must have been carried out in avoluntary, unpaid capacity.3. The voluntary activities must have occurredin the City of Townsville.4. Individuals cannot nominate themselves fora Townsville City Council Seniors Award.5. Only an individual can submit thenomination. An individual may submit anomination on behalf of an organisation.6. The nomination form must be completed in full.7. A separate nomination form must becompleted for each nominee.8. Entries must be submitted in writing.9. Current members of the selection committeewill not be considered for a Townsville CityCouncil Seniors Award.10. Nominations must contain contact details forthe nominee, nominator and two referees.11. The nominator must know the nominee.12. You may nominate a family member.13. A referee cannot be a family member of theperson nominated or the nominator.14. You cannot nominate someone and act astheir referee.15. Make sure you address each of the threeselection criteria. Give examples for eachcriterion so the selection committee knowsthe impact your nominee has had in theTownsville community.16. Responses must not exceed a total of 600 words.17. Use the dot points under each criteria as aguide.18. Provide your written response to theselection criteria on a separate sheet/s ofpaper, and make sure it is either typed orneatly written.19. Copies of information such as citations, mediaclippings or photographs may be attachedto the nomination form to support yournomination but cannot be returned.20. The selection committee’s decision on 2013Townsville City Council Seniors Awardswinner is final.submitting your nomination >>mail >>Seniors AwardsTownsville City Council – Community ServicesPO Box 1268Townsville Qld 4810in person >>Community Development,Level 1, Northtown, 280 Flinders Street,Townsvilleemail >>seniors@townsville.qld.gov.auonline >>www.townsville.qld.gov.auNominations sent by fax will not be accepted.Nominations must bereceived by 5pmFriday 19 July 2013Award presentations will be held duringthe Townsville City Council’s SuperSenior’s Day to be heldReid ParkFriday 23 August 201310.30am – 1.30pmYour responses to the Selection Criteria tellthe selection committee why your nomineedeserves an award.selection criteria >>1. Significant contribution to thecommunityHow has the nominee made asignificant contribution to the TownsvilleCommunity? You should include:>> Information about the fields orareas in which your nomineevolunteers>> Information about theorganisation/s your nomineevolunteers for, and their role in theorganisation/s>> An example/s of how the nomineehas made a difference to theTownsville Community2. Demonstrated commitment tovolunteering in the City of TownsvilleHow has the nominee showncommitment and dedication tovolunteering? You could include:>> Examples of the time or resourcesyour nominee has dedicated to theircommunity or organisation/s>> An example/s of challenges yournominee has overcome3. Demonstrated impact of the volunteeractivities on the Townsville communityWhat is the impact of the nominee’svolunteering activities? You shouldinclude:>> Specific examples of the positiveimpact your nominee has hadon individuals or the Townsvillecommunity>> Information about the importanceof the volunteer work your nomineedoesNominators please remember to list allorganisations and details of the workundertaken for nominees, not just the workfor your organisation.For enquiries or more information, please contact CommunityDevelopment on 1300 878 001 or visit www.townsville.qld.gov.au.page 2

details of person being nominated >>Title: (Mr/Mrs/Ms/Miss) First Name: Surname:Residential Address:Postal Address:Telephone Number: Home Work MobileDate of Birth (mandatory): / /Is date of birth provided exact or estimated (please tick): Exact EstimatedIs the person willing to accept an award? (please tick): Yes No(Please note, if ‘no’ is indicated in this question, this person cannot be nominated)details of person submitting this nomination >>Title: (Mr/Mrs/Ms/Miss) First Name: Surname:Residential Address:Postal Address:Telephone Number: Home Work MobileIf submitting this nomination on behalf of a group or organisation, please state organisation’s name:Signature: Date: / /privacy notice >>The Townsville City Council is collecting the information on this form to assess and administer your nomination for the Seniors Awards.Your nomination form cannot be processed without this information. Council may disclose your personal information if legislation allows orrequires this, or where you have given your permission. The council usually gives some or all of this information to the selection committeemembers. Where selection committee members are external to council they are required to protect your personal information and notdisclose it without your permission.Please provide details of the nominee’s voluntary work and contribution to the community onseparate sheet/s and attach to this nomination form.page 3

eferees >>Please provide the details of two referees who are familiar with the nominee’s volunteer work. We may contact the referee/s for furtherinformation about the volunteer work of the nominee.Referees cannot be:>> the nominator,>> a family member of the nominee or>> a family member of the nominatorReferee 1Title: (Mr/Mrs/Ms/Miss) First Name: Surname:Address:Suburb/Town:Postcode:Position/Organisation (optional):Telephone Number: Home Work MobileEmail:Relationship to Nominee:Signature of Referee (mandatory):Referee 2Title: (Mr/Mrs/Ms/Miss) First Name: Surname:Address:Suburb/Town:Postcode:Position/Organisation (optional):Telephone Number: Home Work MobileEmail:Relationship to Nominee:Signature of Referee (mandatory):checklist >>Before submitting, please carefully check this nomination and ensure that each box is ticked (P) to ensure that you have fully completedand enclosed all of the required information with this nomination.All details for the nominee have been completed.All details for the nominater have been completed.All details for the two referees have been completed.The person that you are nominating is aged 60 years or older.The person that you are nominating is a permanent resident of Townsville.The referee is not a family member of the nominator or nominee.The nominee’s activity has been on a voluntary basis within the city of Townsville.You have responded to each selection criteria.Your response to the selection criteria is more than 300 words, is not more than 600 words, is on a separate page/s and has beenattached to the nomination form.Your response to the selection criteria is typed or handwritten.This nomination addresses all of the criteria and provides enough information to be considered for an award by theTownsville City Council.The information contained in this nomination is true and correct.The person being nominated is aware of this nomination and would be willing to accept an award.page 4