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Last reviewed: Wed, 08 Feb 2012

Nomination form

Please indicate if your nomination is for a Youth Award. This applies to Riccarton/Wigram and Spreydon/Heathcote wards only.

1. Name of person being nominated:

Mr Mrs Miss Ms Other

First Name:
Middle Name(s):
Surname:
Address:
Phone Number:
Email:
Organisation (if applicable):
Relevant Community Board:

2. Nomination submitted by (must have two names)

Nominations with only one nominator will not be eligible for consideration.

Nominator One:

First Name:
Surname:
Address:
Phone Number:
Email (if applicable)

Nominator Two:

First Name:
Surname:
Address:
Phone Number:
Email (if applicable)

3. Nomination Information

Where is the majority of the volunteer work done? (e.g. suburb/area)
What activity/service has the nominee been involved in? (Refer to helpful hint Q2)

How long has the nominee been involved in this activity/service? (Refer to helpful hint Q3)
Supporting information. (Please supply letters of support. These can be from outside clubs/organisations or individuals. E-Mail your supporting documents to . Please make sure you put the name of your nominee in the subject line of the E-Mail.)

Who in the community has benefited, and how, from the Nominee’s activity/service? (Refer to helpful hint Q4)
Supporting information. (Please supply letters of support. These can be from outside clubs/organisations or individuals. E-Mail your supporting documents to . Please make sure you put the name of your nominee in the subject line of the E-Mail.)


4. Complete Submission

 

Authorising Unit: Marketing

Last reviewed: Wednesday, February 08, 2012

Next review: Wednesday, August 08, 2012

Keywords: community awards