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Australia Day Awards Nomination Form

This form is intended for the nomination of residents of the Central Coast area in Tasmania. Nominators are welcome to reside outside the region; however, only individuals who live within the Central Coast area of Tasmania are eligible to be nominated. We appreciate your interest in supporting and recognizing members of our local community.

Step 1 of 4

Nominee Details

(Person/Event to be considered for an Award)

Name(Required)

First Last

Address(Required)

Street Address City County / State / Region ZIP / Postal Code

Phone(Required)

DOB(Required)

Age(Required)

Citizen of the Year

The nominee must be an Australian citizen.
The nominee must reside in the Central Coast area.
Awards will not be granted posthumously.
Self-nominations will not be accepted.

Young Citizen of the Year

The nominee must be an Australian citizen.
The nominee must reside in the Central Coast area.
The nominee must reside in the Central Coast area.
The nominee must be aged 16-30 years, as of 26 January 2026.
Awards will not be granted posthumously.
Self-nominations will not be accepted.

Champion of Sport/s Award

The nominee must be an Australian citizen.
The nominee must reside in the Central Coast area.
Awards will not be granted posthumously.
Self-nominations will not be accepted.

Community Event or Group of the Year

The community event must have been held in the Central Coast municipal area during the past 12 months.
The community group must have provided services or support, or undertaken projects or activities in the Central Coast municipal area during the past 12 months, which made a significant positive impact on the Central Coast community.

Please select one or more awards for the nominee:(Required)

Citizen of the Year

Champion of Sport/s Award

Community Event or Group of the Year

Please select one or more awards for the nominee:(Required)

Citizen of the Year

Young Citizen of the Year

Champion of Sport/s Award

Community Event or Group of the Year

Nominee Achievements (Citizen or Young Citizen Awards)

Describe the contribution the individual has made in the relevant field or program. How have they 'put back' into their field/program to benefit others – including the length of service.(Required)

List example/s where the nominee has been a role model in the Central Coast community, include evidence of leadership, innovation, creativity and/or initiation.(Required)

Demonstrate the impact on the community of Central Coast by the nominee’s contribution to a particular field, town, group or community.(Required)

List contribution/s to the community that have been recognised previously (e.g. in the media, any other awards, achievements, acknowledgements).(Required)

Nominee Achievements (Champion of Sports Award)

Describe the contributions and/or achievements the individual has made with sport in the Central Coast. – including the time of involvement.(Required)

List example/s where the nominee has been a role model in the Central Coast community, include evidence of leadership, innovation, creativity and/or initiation.(Required)

Demonstrate the impact on the community of Central Coast by the nominee’s contribution to a particular sport.(Required)

List contribution/s to the community that have been recognised previously (e.g. in the media, any other awards, significant achievements, acknowledgements).(Required)

Nominee Achievements (Community Event or Group Award)

Describe the impact of the event or group activity on the Central Coast community.(Required)

Detail the level of community involvement and/or community engagement with this event or group (how many people attended or were involved).(Required)

List any other recognition that the event or group has received (eg. in the media, awards, etc).(Required)

Untitled

Demonstrate (if applicable) the community benefit and non-commercial impacts of any fund-raising element of the event/activity for the Central Coast community.(Required)

Referees for Nominee

Please indicate two people who are familiar with the achievements of the nominee and who would (if required) provide a reference for this nomination.

Referee One

Name(Required)

First Last

Address(Required)

Street Address City County / State / Region ZIP / Postal Code

Phone

Mobile(Required)

Email(Required)

Referee Two

Name(Required)

First Last

Address(Required)

Street Address City County / State / Region ZIP / Postal Code

Phone

Mobile(Required)

Email(Required)

Declaration

Signature

Date(Required)

test form

Australia Day Awards Nomination Form

Nominee Details

Citizen of the Year

Young Citizen of the Year

Champion of Sport/s Award

Community Event or Group of the Year

Nominator Details

Nominee Achievements (Citizen or Young Citizen Awards)

Nominee Achievements (Champion of Sports Award)

Nominee Achievements (Community Event or Group Award)

Referees for Nominee

Referee One

Referee Two

Declaration

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