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Simply fill out the form below and submit or download the form and mail to: PO Box 950 Lismore NSW 2480, or fax 6621 8982.
Nominate one of the categores below. (Click here to view Categories info) Category may be changed at the discretion of the KIC Committee
Peer Support - Div1 Peer Support - Div2 Community Support - Div1 Community Support - Div2 Indigenous Youth Support - Div1 Indigenous Youth Support - Div2 Homeless Youth Support - Div1 Homeless Youth Support - Div2 Against All Odds - Div1 Against All Odds - Div2 Role Model Mentor Group or Individual Supporting Youth
In accordance with National and State Privacy and Personal Information Protection legislation and principles, including the "NSW Privacy and Personal Information Protection Act 1998" and "The Privacy Act 1988" (Cth), I permit Kids in Community Inc to keep, store and use photographs of me/our group taken or provided, for advertising and promotional purposes, specifically in relation to the Kids in Community Awards. I understand that this may include printed and electronic publications.
Agree
Please attach nominee photo here (No larger than 2MB please).
Or click here to email us the photo – Don't forget to include nominator's name and name of nominee in photo.
1. Why do you think the person/group you have nominated should receive an award for the category you have chosen? (max 200 words) Read through the category description and ensure your nomination addresses the specific criteria for that category.
2. In relation to the specific category, what do you think inspires or drives the nominee?
3. If the nominee has supported any particular group/s or individual/s please list (include approximate hours per week), otherwise, if not relevant to the nominated category, indicate "not applicable"
4. If the nominee has been awarded any recent certificates of achievement or recognition relevant to the nominated category, please list; otherwise indicate "not applicable". Please do not submit copies of certificates.
5. What is the occupation of the nominee?
----- PLEASE SELECT ----- High School Student TAFE Student Uni Student Working Full Time Working Part Time Unemployed
IMPORTANT: Prior to submitting please PRINT THIS PAGE for your own records. Once submitted you will no longer have access to this form.