2017 City of Ballarat Youth Awards

Nomination Form

Nominee Details

Nominee Name

Nominee Postal Address

Nominee Email

Nominee Phone

Is this person aware that you have nominated them?

Tell us why you are nominating this person or group and why they deserve this award.

Judging criteria for each award is available if requested. Please email youthawards@ballarat.vic.gov.au to obtain a copy of the award criteria.

Nominator Details

Your Name

Your Postal Address

Your Email

Your Phone

I would like this young person to be automatically nominated for the 2017 City of Ballarat Australia Day Award Young Citizen of the Year.

I, the nominator, acknowledge and accept that Youth Services may need to contact me in relation to this nomination.

Privacy Statement

“Personal and or Health Information collected by Council is used for the purpose of contact for 2016 City of Ballarat Youth Awards purposes as specified in the Local Government Act 1989. The Personal and or Health Information will be used solely by Council for these purposes and or directly related purposes. Council may disclose this information to other organisations if required by legislation. The applicant understands that the Personal and or Health Information provided is for the above purpose and that he or she may apply to Council for access to and/or amendment of the information.”

I have read and accept the privacy statement.

City of Ballarat — Youth Awards 2017

Nomination Form

Nominee Details

Leadership in the Arts

Group Project

Nominator Details