2025 Young Citizen of the Year Award

This is a preview of the Young 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. Young Citizen of the Year(Not Applicable)
2. Details of person submitting the nomination(Not Applicable)
3. Acknowledgement(Not Applicable)

Young 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 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 Young Citizen of the Year Award recognises leadership, innovation and creativity among our youngest residents: our youth. The recipient of this award is someone who has shown outstanding achievement in their chosen field, is a role model for others to aspire to and has demonstrated a significant contribution to 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.

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

Must be a date. Nominee must be aged 16 to 30 years as at 26 January 2025 to be eligible in this category

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, and Postcode are required. Country must be Australia

Nominee Home Phone Number

Must be a number.

Nominee Mobile Phone Number

Must be a 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 has the nominee demonstrated leadership, innovation or creativity? *

Please tell us about the nominee's achievements in their chosen field e.g. academics, sports, culture, environment or civic responsibility? List any previous awards or recognition received. *

How is the nominee a role model for other young people? *

How has the nominee contributed to their community? *

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 that can be used in promotion of the Australia Day Awards

Attach a file: