Neighbourhood Watch Australasia
Honours Committee
Coordinated by – Ingrid Stonhill
Chief Executive Officer
Neighbourhood Watch Australasia
2015Neighbourhood Watch Australasia
MALCOLM GRANT OAM
VOLUNTEER MEMBER OF THE YEAR AWARD
To recognise an individual who has volunteered their time through Neighbourhood Watch to empower people and communities through the development of strong and effective partnerships that promotes quality of life, wellbeing and social inclusion.
This application form can be completed and submitted on-line via our website nhwa.com.au or email to:
by the 28th August 2015
PLEASE NOTE WHILE THE LENGTH OF THIS DOCUMENT IS UNRESTRICTED, TWO OR THREE PAGES IS CONSIDERED IDEAL.
PERSON NOMINATED
Name: / State and NHW Region/Division/Area:Address:
Contact Tel. No (Bus. Hrs.): / (After Hrs.):
Length of NHW Service:
Positions held (Please specify whether at NHWState, District/Divisional, or Area level):
NHW Awards/Recognition received previously:
Other external Awards/Recognition received if relevant:
Supporting information pertaining to nomination (refer to Neighbourhood Watch Australasia Award Criteria document) including:
Extent of work in NHW.
Personal contributions to NHW.
Evidence of empowering people and communities and establishing strong and effective partnerships.
Information about how the nominated person upholds one or more of the values of Neighbourhood Watch Australasia (Leadership, Integrity, Support, Inclusiveness, Professionalism and Accountability – refer to the NHWA Future Directions).
Summary of why the nominated personis considered worthy of receiving the Malcolm Grant Volunteer Member of the Year Award
Maximum two to three pages please.
NOMINATED BY
Nominator: / Contact details/telephone:Referee: / Contact details/telephone:
Has the nomination the support of the relevant NHW in the jurisdiction:
Any other information relevant to the nomination:
Any supporting materials, newspaper articles, photos, letters or other information, Please include as PDF or other electronic form if possible. Please also advise if this information is not allowed to be used in NHW magazines or websites.
THANK YOU FOR TAKING THE TIME TO NOMINATE A NHW VOLUNTEER FOR THIS AWARD.