= Required Fields

Online Form - Citizen of the Year Awards Nominations Form

Please provide as much information as possible. Additional documents may be attached providing further information of testimonials of achievement.

Award Category

CITIZENSENIOR CITIZENYOUNG CITIZENCOMMUNITY EVENT

Nominee Full Name: *

Nominee Address

Street Address:

City:

State:

Post Code:

Country:

Nominee Phone *

Nominee Email *

Nominee Date of Birth *

Is the person being nominated an Australian citizen? *

YesNo

How has the person/organisation contributed to the community? *

Please list any other significant contributions and/or achievements? *

Any additional documents

Nominator Name *

Nominator Address

Street Address:

City:

State:

Post Code:

Country:

Nominator Phone *

Nominator Email *

I give permission for the Australia Day Council NT to submit this nomination to other recognition programs such as the Australian of the Year Awards

yes