2025 Citizen of the Year Award

This is a preview of the Citizen of the Year Award 2025 Nomination Form form. When you’re ready to apply, click Fill Out Now to begin.

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1. Citizen of the Year(Not Applicable)
2. Details of Person Submitting Nomination(Not Applicable)
3. Acknowledgement(Not Applicable)

Citizen of the Year

* indicates a required field.

Important Notice (Not Applicable)

Western Downs Regional Council is collecting personal information you supply on this form in accordance with privacy principles in order to facilitate the Australia Day Awards. This information will be accessed by persons who have been authorised to do so. Some of this information may be published in local media, on Council’s website and may be broadcast at the Australia Day function and may be used in future Council publications and reports for the purpose of Australia Day Awards. Your information will not be given to any other person or agency unless required by law. Your personal information is handled in accordance with the Information Privacy Act 2009. If you provide Council with any personal information about another person, you should ensure that you are authorised to do so.

The Western Downs Regional Council Citizen of the Year Award recognises outstanding achievement, innovation, creativity, leadership and vision at the highest level. The recipient of this award is someone who is an inspiration to their peers, has shown a significant and outstanding contribution to their community and has demonstrated a high level of personal, academic or professional achievement, including benefits for others.

Nominee Details (this is about the person being nominated) (Not Applicable)

Nominee *

Title	First name	Last name

NB Nominees must reside within the Western Downs Regional Council area, or alternatively, where this is not the case, the nomination must demonstrate that a significant contribution has been made by the nominee to the Western Downs Regional Council community and that they are considered to be a part of the community.

Is the nominee an Australian Citizen? *

Response required.

Yes

Clear

If no, nominee is not eligible for consideration for the Western Downs Regional Council Australia Day Awards

Nominee Date of Birth (this is to confirm that the nominee is over 30 years of age as at 26 January 2025) *

Nominee Postal Address *

Return to address search

Address line 1

Address line 2

Suburb/Town	State/Province	Postcode

Country

Address Line 1, Suburb/Town, and Postcode are required. Country must be Australia

Nominee Home Phone Number

Must be an Australian phone number.

Nominee Mobile Phone Number

Must be an Australian phone number.

Nominee Email Address (if known)

Occupation *

Nominee Profile (Not Applicable)

Please ensure that you answer each question fully and with as much detail as possible. The information supplied in your application will be used by the assessment panel to make a final decision. Assume that the assessment panel do not know anything about the person being nominated, so give as much information as possible.

Please provide a short summary about the person you are nominating that Council may use for our media and promotion. *

How is the nominee an inspiration/positive role model for their peer/community/region? *

What significant and outstanding contribution has the nominee made (and continues to make) in the community? *

How has the nominee demonstrated a high level of personal, academic or professional achievement? Please tell us how this has benefited the community or other people. *

How has the nominee shown vision, leadership, innovation or creativity? *

Please attach any supporting materials, e.g. media articles (social and print media), copies of other awards and achievements, and personal references. This information is highly valued by the selection committee to help inform their decision. *

Attach a file:

Please attach a current photograph of the nominee which can be used in promotion of the Australia Day Awards

Attach a file: