Page 1 - 2020 ACT Women's Awards and Honour Roll - Community Services Directorate

Award Category (Not Applicable)

The category you are nominating the nominee for (self nominations will not be considered)

Please select from the following categories *

Response required.Response required.

ACT Woman of the Year - all nominees will be entered in this category

ACT Senior Woman of the Year - nominees must be aged 60 years or over

ACT Young Woman of the Year - nominees must be aged 16 to 25 years

ACT Women's Honour Roll AND ACT Woman of the Year

ACT Women's Honour Roll

Clear the selected value for Please select from the following categories

Nominee (Not Applicable)

The person you are nominating

Nominee Name *

Title	First Name	Last Name

Nominee Primary Phone Number *

Must be an Australian phone number.

Nominee Alternative Phone Number

Must be an Australian phone number.

Nominee Email *

Nominee Address *

Address line 1

Address line 2

Suburb	State	Postcode

Nominee Date of Birth *

Must be a date.

Is the nominee Aboriginal and/or Torres Strait Islander? *

Response required.

Yes

No

Clear the selected value for Is the nominee Aboriginal and/or Torres Strait Islander?

This section is not applicable because of your response to question: "Is the nominee Aboriginal and/or Torres Strait Islander?" on page 1

If Yes:

Is the nominee from a culturally and linguistically diverse background? *

Response required.Response required.

Yes

No

Clear the selected value for Is the nominee from a culturally and linguistically diverse background?

This section is not applicable because of your response to question: "Is the nominee from a culturally and linguistically diverse background?" on page 1

If yes, what is the nominee's country of birth?

Linking in with other awards (Not Applicable)

Please note:

Winners of each category of the 2020 ACT Women’s Awards, will be automatically included in the 2020 ACT Women’s Honour Roll.

Recipients of each category of the 2020 ACT Women’s Awards will also be entered for consideration for the Australian of the Year Awards, unless the nominee requests otherwise.

Nominee details will be forwarded for consideration for other relevant ACT Government Awards unless the nominator or nominee requests otherwise.

Selection Criteria (Not Applicable)

This section is not applicable because of your response to questions:

"Please select from the following categories" on page 1
"Please select from the following categories" on page 1

Women's Awards Nomination

Please tell us about your nominee

In what ways has the nominee demonstrated an outstanding contribution in improving the status and lives of women and girls in the ACT? *

Please provide an indication of the number of women positively impacted by the work of the nominee and the significance of the impact. *

Must be no more than 400 words.

Over what period of time has the nominee made their contribution to improving the status and lives of women and girls in the ACT? *

Supporting Documentation (Not Applicable)

Please upload any supporting documentation

New Question

Attach a file:

(Includes references, resumes, articles)

Honour Roll Nomination (Not Applicable)

This section is not applicable because of your response to question: "Please select from the following categories" on page 1

Please tell us about your nominee.

Supporting Documentation (Not Applicable)

This section is not applicable because of your response to questions:

"Please select from the following categories" on page 1
"Please select from the following categories" on page 1

Please upload any supporting documentation

(Includes references, resumes, articles)

Nominator - your details (Not Applicable)

Nominator Name *

Title	First Name	Last Name

Nominator Primary Phone Number *

Must be an Australian phone number.

Nominator Alternative Phone Number

Must be an Australian phone number.

Nominator Email *

How do you know the nominee? *

Where did you hear about these Awards?

Referee details (Not Applicable)

The Nominator must provide a referee contact whom the Territory may contact to seek feedback on the Nominee. You may elect to provide up to three referees.

Referee Name *

Title	First Name	Last Name

Referee Primary Phone Number *

Must be an Australian phone number.

Referee Alternative Phone Number

Must be an Australian phone number.

Referee Email *

Who is this referee, and why is their support relevant?

Second Referee details (Not Applicable)

Referee Name

Title	First Name	Last Name

Referee Primary Phone Number

Must be an Australian phone number.

Referee Email

Must be an email address.

Referee Other Phone Number

Must be an Australian phone number.

Who is this referee, and why is their support relevant?

Third Referee details (Not Applicable)

Referee

Title	First Name	Last Name

Referee Primary Phone Number

Must be an Australian phone number.

Referee Primary Email

Must be an email address.

Referee Other Phone Number

Must be an Australian phone number.

Who is this referee, and why is their support relevant?

Need help or more information? (Not Applicable)

If you need assistance or have any enquiries, please contact:

ACT Office for Women

Telephone: (02) 6205 1075

E-mail: women@act.gov.au

2020 ACT Women's Awards and Honour Roll

Form Navigation

2020 ACT Women's Awards and Honour Roll Nomination Form

Award Category (Not Applicable)

Nominee (Not Applicable)

Linking in with other awards (Not Applicable)

Selection Criteria (Not Applicable)

Supporting Documentation (Not Applicable)

Honour Roll Nomination (Not Applicable)

Supporting Documentation (Not Applicable)

Nominator - your details (Not Applicable)

Referee details (Not Applicable)

Second Referee details (Not Applicable)

Third Referee details (Not Applicable)

Need help or more information? (Not Applicable)