2025 Local Sports Award

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

Local Sports Award

* indicates a required field.

Important Notice

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 Councils 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 theInformation 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 Local Sports Award recognises those kicking goals in their athletic pursuits. Recipients of this award are outstanding sportspeople with noteworthy records and are role models others can aspire to.

Local District

Please select which district the person you are nominating is located * Required
Response required.
Clear the selected value for Please select which district the person you are nominating is located
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.

Nominee Details (this is about the person being nominated)

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? * Required
Response required.
Clear the selected value for Is the nominee an Australian Citizen?
Address Line 1, Suburb/Town, and Postcode are required. Country must be Australia 
Must be an Australian phone number. 
Must be an Australian phone number. 
Must be an email address. 
Must be a date. If nominee is 18 years of age or under as at 26 January 2025 submit the nomination in the Junior category. Nominees 19 years or over as at 26 January 2025 will be classed as Senior category.
Is the nominee competing in their chosen sport at a minimum level of selection in a State team or have won a State Title (or equivalent) in their chosen sport. * Required
Response required.

Nominee Profile

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.

In which category are you submitting this nomination? * Required
Response required.
Clear the selected value for In which category are you submitting this nomination?

Junior category (18 years of age or under as at 26 January 2025) (Not Applicable)

This section is not applicable because of your response to question: "In which category are you submitting this nomination?" on page 1

Attach a file: Select stored file
    Attach a file: Select stored file

      Senior category (19 years or over as at 26 January 2025) (Not Applicable)

      This section is not applicable because of your response to question: "In which category are you submitting this nomination?" on page 1

      Attach a file: Select stored file
        Attach a file: Select stored file