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38 AttachmentNorthern Ruapehu Citizens AwardImportant NoteIn order to assist the Chairpersons of the Taumarunui-Ohura Ward Committee and National ParkCommunity Board and Ohura Councillor to make a well-informed decision on the recipient of thisAward, nominations should be accompanied with precise details of activities and achievements forwhich recognition is sought.Additional information should be completed on a separate sheet and attached to this form.General InformationPlease return the completed nomination form to:The Chief ExecutiveRuapehu District CouncilPrivate Bag 1001TAUMARUNUI 3946Nominations close:Friday 11 October 2013Please Note: It is a condition of nomination that the Committee and Board’s decision is final and nocorrespondence will be entered into.Criteria for Award1. Criteria for Award1.1 Unsuccessful nominees may be re-nominated in the following or subsequent years.Nominations made in previous years are not automatically carried forward and freshnominations should be made. A Queen’s Honour Award (for example, QSM) for the sameactivity as the person is nominated for, renders that person ineligible for a civic award.1.2 Nominations for the Citizens Award will be called for by public notice each year.1.3 Nominations should be made by two individuals or organisations. All details on thenomination form must be completed.2. Criteria for Nominees2.1 Voluntary, unpaid work – going above and beyond the call of duty consistently for nopersonal gain.2.2 Significant contribution over an extended period of time – unselfish sacrifice of time andresources.2.3 Work was for the benefit of the community – participation in a range of activities.2.4 Work was for the sick, elderly, disadvantaged, youth or any service organisation – unsunghero.Please turn over to complete details of Nominee and NominatorsNOMINATIONS CLOSE: FRIDAY 11 OCTOBER 2013
39 AttachmentNominee DetailsFull Name of Nominee (Mr/Mrs/Miss/Ms/Other):Address (Not PO Box No):Phone Number:Occupation/Profession:(If retired, state previous occupation/profession):Field of Service for which Recognition is sought:Has Nominee been the recipient of any otherAward/Decoration? If so, please give details.(Note: Nomination of persons recognised by HerMajesty the Queen are not considered eligible.)History of Services Rendered:(Please attach details regardinghistory of services rendered by thenominee, together with copies ofany supporting letters and otherrelevant information.)To be Completed by NominatorsForm to be completed by two nominators or organisations. Please write clearly using block letters.We nominate the under-mentioned person to be considered for the Northern Ruapehu Citizens Award inrecognition of the voluntary and meritorious service rendered to the community in the Taumarunui, Ohura orNational Park areas. The Award will be made for unpaid, outstanding, significant and unselfish contributions.Name:Address:1 st Nominator/Organisation Details 2 nd Nominator/Organisation DetailsPhone No:Club/Organisation:Position in Club/Organisation:(eg, President/Secretary)Signature:Date:Privacy: This information is collected purely for the consideration of nominations for the Northern Ruapehu Citizens AwardNOMINATIONS CLOSE: FRIDAY 11 OCTOBER 2013
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Page 10 and 11: 10Report to: Taumarunui/Ohura Ward
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