Nomination Form

Nominate check ONE category only. (Click here to view Categories info)
Nominated category may be changed at the discretion of the KIC Committee

Items marked with* MUST BE completed

• Young People Supporting

  1 - Youth in General
  2 - Indigenous Youth
  3 - Diverse Youth
  4 - Community

  Young People Achieving

  5 - Role Models
  6 - Against All Odds

  Young People Supporting

  7 - Individual Mentors
  8 - Supporting Groups
  9 - Media Reporting

Nominee Details

• Name*
• Age* 13 14 15 16 17 18 19 20 21 22 23 24 25 26+
• Address*
• Town*
• Postcode*
• Home Phone*
• Work Phone
• Mobile
• Email*
• School, Group, Organisation*

Nominator's Details

• Your Name*
• Age* selected="selected"> 13 14 15 16 17 18 19 20 21 22 23 24 25 26+
• Your Email*
• Address*
• Town*
• Postcode*
• Home Phone*
• Work Phone
• Mobile
• Relationship*
• Organisation

Referee details

• Name*
• Phone*
• Mobile

Permission to use Image

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.

Nominee's Contribution

Please be as clear and concise as possible.

1. Why do you think the person/group you have nominated should receive an award in your chosen category?  (max 1350 characters) Read through the category description and tailor your nomination accordingly.
MEDIA Reporting Nominees - Give details of where and when stories appeared & attached copies (Max of 3).

 Please note, only 1350 characters will be submittedALERT! Too many characters, Delete some, 1350 allowed..

Media reporting nominees only

2. Please outline how the nominee’s contribution meets one, or more, of the following KIC judging criteria? They don’t need to meet all of them.

Inspires, engages or includes other young people

 A maximum of 500 characters are allowedExceeded maximum number of characters.

Helps more disadvantaged or excluded groups or individuals

 A value is required.A maximum of 500 characters are allowed

Makes an impact in their community

 A value is required.A maximum of 500 characters are allowed

Goes beyond their normal school or work activities

 A value is required.A maximum of 500 characters are allowed

Fosters better relationships between different social, ethnic or cultural groups

 A value is required.A maximum of 500 characters are allowed

3. Please describe any personal challenges faced by the nominee? These details are used for judging purposes only and will be kept confidential.

 A value is required.A maximum of 500 characters are allowed

4. Do you feel being nominated for a KIC award will benefit the nominee’s self-esteem and confidence...?
Please select an answer select Not much A little Quite a bit Very much

IMPORTANT: Prior to submitting please PRINT THIS PAGE for your own records. Once submitted you will no longer have access to this form.