Page 1 - 2027 Local Sports Award - Western Downs Regional Council

Important Notice (Not Applicable)

Western Downs Regional Council is committed to handling your personal information in accordance with the Information Privacy Act 2009 (Qld) and the Queensland Privacy Principles (QPPs).

QPP 5 obliges Council to advise you of certain matters when collecting your personal information.

This collection notice sets out those matters, and explains how we will manage the collection, use, disclosure and storage of your personal information.

The personal information collected on this form will be used to process applications under the Australia Day Awards Program. The personal information you supply on this form in accordance with Local Government Act 2009.

If you choose not to provide your personal information, for example your name and contact details, Council will not be able to consider your nomination.

Your personal information will be accessed by persons who have been authorised to do so. Your information will not be given to any other person or agency unless required by law. 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.

Council's privacy policy explains how you may request access to and/or seek correction of your personal information. Council's policy also explains how you can complain to Council if you consider Council has breached its obligations to manage your personal information in accordance with the QPPs, and how we deal with privacy complaints.

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 (Not Applicable)

Local District *

Response required.

Chinchilla & District (including Brigalow and Kogan districts)

Dalby & District (including Dalby town and surrounds)

Jandowae & District (including Bell, Jimbour, Kaimkillenbun and Warra districts)

Miles & District (including Condamine, Drillham and Dulacca districts)

Tara & District (including Glenmorgan, Hannaford, Meandarra, Moonie and The Gums districts)

Wandoan & District (including Grosmont and Guluguba districts)

Clear

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) (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

No (if NO, they are not eligible to receive an Australia Day Award)

Clear

Nominee Postal Address *

Return to address search

Address line 1

Address line 2

Suburb/Town

State/Province

Postcode

Country

Address Line 1, Suburb/Town, State/Province, Postcode, and Country are required.

Nominee Home Phone Number

Must be an Australian phone number.

Nominee Mobile Phone Number

Must be an Australian phone number.

Nominee Primary Email (if known)

Must be an email address.

Nominee Date of Birth (this is to confirm whether nominee is eligible for the Junior or Senior category) *

Must be a date. If nominee is 18 years of age or under as at 26 January 2027 submit the nomination in the Junior category. Nominees 19 years or over as at 26 January 2027 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. *

Response required.

Yes

No (if no the nominee is not eligible to receive an Australia Day Award)

Clear

Nominee Profile (Not Applicable)

Please provide a short summary (between 50 and 100 words) about the person you are nominating. Council may use your response for media and promotion. *

Word count:

Must be between 50 and 100 words.

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? *

Response required.

Junior (18 years or under as at 26 January 2026)

Senior (19 years or over as at 26 January 2026)

Clear

Junior category (18 years of age or under as at 26 January 2027) (Not Applicable)

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

Tell us about how the nominee is an outstanding sportsperson with a noteworthy record of achievement in sport. *

Tell us how the nominee has represented their sport in a fair and positive manner. *

Please attach all materials to support the nomination.

Example may include:

media articles (social and print media)
copies of other awards and achievements
personal references

This information is highly valued by the selection committee to help inform their decision.

Please attach any supporting materials *

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

Senior category (19 years or over as at 26 January 2027) (Not Applicable)

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

Tell us about how the nominee is an outstanding sportsperson with a noteworthy record of achievement in sport. *

Tell us about how the nominee is a role model that people can aspire to. *

Tell us how the nominee has represented their sport in a fair and positive manner. *

Please attach all materials to support the nomination.

Example may include:

media articles (social and print media)
copies of other awards and achievements
personal references

This information is highly valued by the selection committee to help inform their decision.

Please attach any supporting materials *

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

Your session is about to expire

2027 Local Sports Award

Local Sports Award

Important Notice (Not Applicable)

Local District (Not Applicable)

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

Nominee Profile (Not Applicable)

Junior category (18 years of age or under as at 26 January 2027) (Not Applicable)

Senior category (19 years or over as at 26 January 2027) (Not Applicable)