Australia Day Awards 2021 Nomination Form

Thanks for your interest in nominating someone for the Australia Day Awards 2021. These prestigious honours are an important part of the Borough of Queenscliffe's annual Australia Day celebrations. Your submission helps us recognise the most deserving winners each year.

View the selection criteria

Conditions of entry:

  • Nominations must be submitted on Council's official nomination form.
  • Nominations must be received by 4:00pm on Friday 20 November 2020.
  • In the event that no nominations are received in any of the categories, the Australia Day Awards Reference Group reserves the right to grant the award to a group, event or citizen of its choice.
  • No awards will be made if it is considered that nominations are not of a sufficiently high standard.
  • The decision of the Australia Day Awards Reference Group is final and no correspondence will be entered into in regards to that decision.
 australia day logo

For more information on the Australia Day Awards and the criteria for assessment in each category, visit this page.

Note: To avoid the risk of data loss via a page timeout or accidental shutdown, it is recommended that you construct your answers in a Word document and paste them in to this form when you have completed them.

Preliminary checklist
Nomination type
Nominee details
Nominator details
Submission details

The following section pertains to your submission outlining the background, reason for nomination, achievements, and how the nominee inspires the community. At the bottom of the page, you may also upload an attachment of supporting material such as certificates, awards, newspaper clippings, and more.


Privacy note: Council collects personal information to fulfil its statutory obligations, and to ensure that it can provide services to you. In some instances Council cannot provide some of its services unless you provide us with necessary information. Council will only use personal information for the purposes for which it was collected. Council staff are happy to discuss your privacy queries, however if you require further assistance you should contact our Privacy Officer on 03 5258 1377.