2018 Youth Awards Nomination Form The Youth Awards celebrate and recognise the amazing young people aged between 12 and 25 years of age who live, work or study within the Mildura Rural City Council area. The Youth Awards ceremony is held annually during National Youth Week.

Nominations will be judged based on the award criteria and the information provided on this form.

Information on the award categories can be found at www.mildura.vic.gov.au/Youth or by calling the Youth Services Team on (03) 5018 8100.

When filling in the nomination, please provide as much relevant information as possible and any supporting documentation you think appropriate to support this application. For people being nominated for more than one category they are required to fill in one Application Form per category.

Nominees who are shortlisted for an award will be required to take part in an interview process.

Nomination close on Friday, 2 March 2018

Please select category that indicates the award you are nominating the individual or group for:

Youth Carer Award Youth Individual Artist Award

Youth Volunteer Award Youth Group Artist Award

Youth Group Award Environmental Award

Individual Name (for Individual awards)

     

Group Name (for Group Awards)

     

Contact Person (for Group Awards)

     

Main purpose of the group

     

Number of members       Years in operation      

Please provide details of nominated young person or main group contact

First name       Surname      

Date of Birth       Age       Gender Male Female

Postal Address      

Contact Phone      

Email Address      

Have you asked the young person or group for nomination permission? Yes No

Do you consent to this information being submitted to another Council Department as a nomination for the MRCC Australia Day Awards? bit.ly/2bWCCkIIs the Young Person an Australian Citizen? (required for Australia Day nomination)

Yes

Yes

No

No

Details of person or organisation submitting the nomination

First name       Surname      

Organisation (if applicable)      

Postal Address      

Email Address       Contact Phone      

Please provide the name and contact details of a referee who can support this nomination?

     

Please provide a brief description of the person or group you are nominating for this award:

     

Describe the young person or group achievements in relation to the category areas or list any highlights:

     

Describe why you believe this young person should receive the Youth Award:

     

Please provide any other information you feel may be relevant to support this nomination:

     

How did you hear about the Youth Awards?

Newspaper School Word of Mouth Facebook

Website Other ___________________________

MILDURA RURAL CITY COUNCIL PROVACY COLLECTION STATEMENT

Mildura Rural City Council collects Personal and or Health Information for municipal purposes as specified in the Privacy and Data Protection Act 2014.  The information collected in this form is used only for the purposes specified (primary purpose) and is not passed on to third parties.  Council may disclose this information but only if authorised or required by law.  Council may not be able to process your request unless sufficient information is given.  Should you need to change or access your personal details, or you require further information regarding Council’s Privacy Policy please contact Council’s Privacy Officer.