2027 Local Volunteer of the Year Award

This is a preview of the Local Volunteer of the Year Award 2027 Nomination Form form. When you’re ready to apply, click Fill Out Now to begin.

Local Volunteer of the Year

* indicates a required field.

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 Volunteer of the Year Award recognises those who go above and beyond in their service to others. Recipients of this award have made a significant contribution to their community through volunteering and have shown a personal effort that has made a lasting and significant difference to those around them.

Local District (Not Applicable)

Please select which district the person you are nominating is located *

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

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 *

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Address line 1

Address line 2

Suburb/Town

State/Province

Postcode

Country

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

Occupation *

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 aspossible.

Please tell us about the nominee's volunteering contributions in the community. *

How have the nominee's volunteering efforts made a lasting and significant difference to their community? *

Supporting Materials (Not Applicable)

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 *

Attach a file: Upload new file

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