Local hero nomination

Required fields are marked with an asterisk (*).

Nominee details

1. Nominee's title (eg Mr/Mrs/Ms/Other) *

2. Nominee's full name *

3. Nominee's contact details * Please provide contact details for your nominee. If these are unknown, please provide as much information as possible to allow Council to contact them, eg workplace, organisation they volunteer for.

4. Describe the nominee’s contribution to the community: * Please provide as much detail as you can to help the judges in their decision. Suggestions:

Describe the nominee and why you believe they should be considered.

How has the nominee been an inspirational role model for our community?

How many years’ service have they provided?

What local organisations have they served with/supported?

How has the community benefitted from their service or contribution?

What are some examples of how the nominee has gone “above and beyond”?

Whether they worked as part of a team and their role within it.

Whether they had to overcome any difficulties or hurdles.

Other outstanding achievements by the nominee.

Other recognition of the nominee’s contribution or work, including publicity.

Your details

5 Your title (eg Mr/Mrs/Ms/Other) *

6. Your full name *

7. Your postal address *

8. Your phone number *

9. Your email address *

10. Your relationship to the nominee *

11. Declaration *

I have read the Local Hero Award guidelines.
I declare that the information I have provided relating to the nominee is, to the best of my knowledge, true and accurate.