South Melbourne - celebrating people and place
NOMINATION FORM
The City of Port Phillip is calling for nominations of people significant to the South Melbourne area whose names can be allocated to the new Emerald Hill Reserve and laneways during 2015.
An edited selection of nominations will be published on the heritage website heritage.portphillip.vic.gov.au.
Nominations open 3 October 2014 and close 5 December 2014.
Section 1: Nomination summary
Nominee (name of person, organisation or event proposed for park/ lane naming)
/Reason for proposing this person
(50 word statement of significance)A description of the suggested name and why it is being proposed /
Name
(Personmaking the submission)
/Organisation
(where relevant)
/Position in organisation (where relevant)
/Postal address
/Suburb
/ /Postcode
/Phone
/ /Mobile
/Section 2: Selection criteria
Selection Criteria
/Comments
1. Summary of the life and achievements of the person including:- Full name, date of birth, date of death
- Occupation and education
- Civil and community achievements
- Honours and awards conferred
2. Contribution to history
What isthe highly significant contribution to
the shared community history of the CoPP, which is also significant at a state or national level, made by the Nominee?
(400 words max) /
3. Level of achievement
Demonstrate that the Nominee has achieved at a high level and made their contribution over and above what might be reasonably expected through paid employment.
If this is a voluntary contribution to the community, it should stand out from others who may have also made valuable contributions.
(200 words max) /
4. Tangible legacy
What is the tangible legacy that the Nominee has left to the community?
Include whether to City of Port Phillip, Victoria or Australia
(200 words max) /
5. Relevance to place
What is the highly significant relationship between the Nominee and the area of
South Melbourne? /
6. Community Support
Do other individuals or groups support this application? /
7. Further comments /
Section 3: Administration (to be completed by CoPP staff)
Date received
/Date submitted
for review
/Nominations can be submitted:
By mail to:
Art & Heritage Team Leader
Private Bag No 3
PO St Kilda
Victoria 3182
03 9209 6496
By email to:
art&
In person at:
ASSIST counters, Town Halls
Online at:
heritage.portphillip.vic.gov.au/heritage_matters/south_melbourne
The personal information requested on this form is being collected by the City of Port Phillip for communication about the reserve and laneways nomination process and outcomes. The personal information will be used solely by the Council for that primary purpose or directly related purposes. The applicant understands that the personal information provided is for these purposes and that he or she may apply to the Council for access to and/or amendment of the information. Requests for access and or correction should be made to or telephone 9209 6777.