Online Form - Australia Day Citizenship Nominations - Australia Day 2025

Award recipients must meet the following eligibility criteria:

Recipients must be; residents of the Shire; or have coordinated a community event Within the Shire; or be members of a
community group whose principal activities are conducted within the Shire; or be a business or organisation that has
contributed financially or in-kind to a community project or group within the Shire
Awards cannot be granted posthumously
Only one person (not a couple or group) may be nominated for individual award categories
Local Government Councillors, State and Federal politicians are not eligible to receive an Award
Sitting members of State, Federal and Local Government are not eligible.

Nominations close 4pm Monday, 13 January 2025.

Category and criteria

Please choose one of the following:*

YOUTH AWARD - Presented to an individual under 25 years of age who has made an outstanding contribution to the local community.
CITIZEN AWARD - Presented to an individual over 25 years of age who has made an outstanding contribution to the local community.
SENIORS AWARD - Presented to an individual over 65 years of age who has made an outstanding contribution to the local community.
EVENT - Presented to a individual or organisers/committee of an event held in the Shire of Coolgardie that has made an outstanding contribution to the local community.
CORPORATE CITIZEN AWARD - Presented to a business or organisation that has made an outstanding contribution (financial or in-kind) to the community in the Shire of Coolgardie.
COMMUNITY GROUP - Presented to a community group in the Shire of Coolgardie that has made an outstanding contribution to the local community.

Name of Nominee*

Nominee Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Nominee Contact Number*

Nominee Email Address

Nominator Name*

Nominator Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Nominator Contact Number*

Nominator Email Address

Please list examples of how this person/organisation has made a significant contribution within the previous calendar year to the community.*