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NOMINATOR
Title Given Names
Surname
Address
Suburb/Town State
Postcode
Telephone (Home) (Work) (Mobile)
Todays date
OTHER PERSON WILLING TO SUPPORT YOUR NOMINATION
Title Given Names
Surname
Address
Suburb/Town State
Postcode
Telephone (Home) (Work) (Mobile)
*For Walk of Fame nominees, addi� onal nomina� on details are required, please see criteria on overleaf.
WALK OF FAME DEADLINE: FRIDAY 27 OCTOBER 2017AWARDS DEADLINE: MONDAY 8 JANUARY 2018
City of Kalgoorlie-Boulder Australia Day Awards
NOMINATION FORMNOMINATION FOR: Australia Day Ci� zen Award Walk of Fame
Australia Day Community Group or Event of the Year Award (please � ck Group or Event)
*In additi on to the main awards, the Mayor, at his discreti on, may select a worthy nominee that has made a signifi cant contributi on to the community to
recieve the ‘Mayoral Award’.
NOMINEES DETAILS
Title Given Names
Surname
Group (if applicable)
Address
Suburb/Town State
Postcode
Telephone (Home) (Work) (Mobile)
REASONS FOR NOMINATION (Include nominee’s contribu� on to community life, past and present involvement in community groups)
HAS THE NOMINEE’S CONTRIBUTION BEEN RECOGNISED ELSEWHERE? IF SO, PLEASE LIST
GuidelinesEach year a local ci� zen/s and one local community group in the City of Kalgoorlie-Boulder will be eligible for the Australia Day Awards.
The recipients will be selected from people and groups who have made a noteworthy contribu� on during the current year, or given outstanding service to the local community over a number of years through ac� ve involvement.
The City of Kalgoorlie-Boulder Australia Day Awards provides awards each year for presenta� on at the “Big Aussie Breakfast” on Australia Day.
Nomina� on ProcessThe City of Kalgoorlie-Boulder invites nomina� ons for the awards from community groups and private ci� zens.
Nomina� on forms will be available from the following loca� ons: 1. City of Kalgoorlie-Boulder website www.ckb.wa.gov.au
2. City of Kalgoorlie-Boulder Customer Service CentreShop 8-10 Market Arcade, Entrance off Hannan Street
3. City of Kalgoorlie-Boulder Administra� on Building577 Hannan Street, Kalgoorlie
4. William Grundt Memorial Library13 Roberts Street, Kalgoorlie
5. Eastern Goldfi elds Community Centre13 Roberts Street, Kalgoorlie
6. Goldfi elds Oasis, 99 Johnston Street, Boulder
7. Kalgoorlie-Boulder Visitor CentreKalgoorlie Town Hall, Corner Hannan and Wilson Street
Should you wish to be included on the mailing listto receive a nomina� on form please contact:The City of Kalgoorlie-Boulder577 Hannan Street, KalgoorliePO Box 2042, Boulder WA 6432Telephone: (08) 9021 9600Facsimile: (08) 9021 6113Email: [email protected]
Selec� on CriteriaThe winners will be judged on their ac� ve ci� zenship and:• Signifi cant contribu� on to the local community.
• Demonstrated leadership on a community issue rela� ng to theenhancement of community life.
• A signifi cant ini� a� ve which has brought about a posi� ve changeand added value to community life.
• Inspiring quali� es as a role model for the community.
Eligibility• Nominees should reside or work principally within the locality of
Kalgoorlie-Boulder.
• Awards may be granted posthumously in recogni� on of recentachievements.
• Groups of people or couples will not normally be eligible exceptwhen mee� ng the criteria for a community group.
• A person cannot receive the same award twice, but can beconsidered for another award.
• Unsuccessful nominees may be nominated in future years.
• Si� ng members of State, Federal and Local Government arenot eligible for nomina� on for work undertaken in their offi cialcapacity.
Judging ProcessAll category winners of the City of Kalgoorlie-Boulder Australia Day Awards will be selected from nomina� ons received from the community. The judging panel will be made up of representa� ves from the City of Kalgoorlie-Boulder.
These pres� gious awards are only available to one recipient in each category in each year. The judges’ decision will be fi nal and no correspondence will be entered into by the City of Kalgoorlie-Boulder.
The City of Kalgoorlie-Boulder reserves the right to redefi ne categories to accommodate outstanding nomina� ons.
Presenta� on of AwardsAwards will be presented at the “Big Aussie Breakfast” on Australia Day, 26 January 2018 at Centennial Park.
For more informa� on, please contact the Execu� ve Assistant to the CEO on on 9021 9600 or email [email protected]
NOMINATION GUIDELINESThe City of Kalgoorlie-Boulder Walk of Fame commi� ee is now calling for nomina� ons for the Kalgoorlie-Boulder Walk of Fame.
During 2017, the Walk of Fame Commi� ee will consider the recogni� on of at least 1 outstanding Kalgoorlie-Boulder individual with a plaque to be placed on the Eastern end of Hannan Street in the Kalgoorlie CBD.
Recipients will be recognised for their signifi cant and posi� ve contribu� on to the region of the City of Kalgoorlie-Boulder and its people.
The 2017 recipient/s will be announced at the 2018 Australia Day Awards Ceremony as part of the Australia Day breakfast.
CRITERIA1. Nomina� ons are to be received by the City of Kalgoorlie-Boulder by close of business Friday 27 October 2017. Latenomina� ons will not be accepted.
2. NOMINATION FORMS can be fi lled in online at theCity of Kalgoorlie-Boulder website www.ckb.wa.gov.au ora hard copy is available at the City of Kalgoorlie-BoulderAdministra� on Building.
3. Unless comple� ng online, all correspondence should beaddressed to the Execu� ve Assistant of the Walk of FameCommi� ee c/o City of Kalgoorlie-Boulder PO Box 2042Boulder WA 6432.
4. The nominee must have made a signifi cant and posi� vecontribu� on to the people and the region of the City ofKalgoorlie-Boulder.
5. Nomina� ons are for individuals only, groups are notaccepted.
6. The selec� on commi� ee will have the fi nal decision andno other correspondence will be entered into.
7. Lobbying of the Selec� on Panel or the Council is notacceptable and may result in the disqualifi ca� on of thenomina� on.
8. Nominees must reside or have resided in the regionknown as the City of Kalgoorlie-Boulder.
9.Nomina� ons are retained and reviewed in each awardyear therea� er.
CITY OF KALGOORLIE-BOULDER AUSTRALIA DAY AWARDS
Day, 26 January 2018 at Centennial Park.
For more informa� on, please contact the Execu� ve Assistant to the CEO on on 9021 9600 or email [email protected]
