Please complete the following form to nominate for Male, Female, Master or Junior Sportsperson of the Year.
Please select award category :
---Female Sportsperson of the YearJunior Sportsperson of the YearMale Sportsperson of the YearMasters Sportsperson of the Year
First Name * :
Last Name * :
Address * :
Suburb * :
State * :
Postcode * :
Mobile * :
Email * :
Sport or recreation type * :
Team Name (where applicable) :
Organisation (where applicable) :
Is the nominee aware of this nomination? *:
I am self nominating.
Relationship to nominee (ie. Family member, colleague, coach, organisation) * :
How did you find out about the awards?
---DSR websiteDSRF websiteDSR Vortex NewsletterDSR emailState Sporting AssociationDisability sports organisationCommunity organisationLocal clubCouncilOther (please specify)
Please specify the other
1. In the past twelve months, the nominee has participated:Please select all that are applicable.
Local competition Regional competition State competition National competition International competition
Please provide further explanation (maximum 50 words)
2. The nominee is aged
---25 years or under26-39 years old40 years or above
3. How long has the nominee been involved in the sport/program?
4. The following relate to the nominee’s impact. The nominee has:Please select all that are applicable.
Made considerable improvements in their performances and achievements Consistently beat personal bests or previously set records Attended practice and training sessions with enthusiasm and energy Made a significant impact in their sport or in their team/club
5. The following relate to the nominee’s attitude and sportsmanship. The nominee has:Please select all that are applicable.
Been a role model for others Displays sportsperson-like conduct on and off the playing area Makes an effort to be a fair leader Shown respect for the coach, referee and their teammates Shown good work ethic and ambassadorship for their sport Taken on a position of responsibility in the club? eg. team captain Acted as a mentor for teammates Volunteered in their sport / program Coached or assisted in developing other players
6. Please summarise the nominee’s achievements in 150 words or less.
You may attach supporting evidence (no more than three A4 pages)(Allowed file types:gif|png|jpg|jpeg|pdf & file size max 2mb)
Please upload one – two photos of the nominee.(Allowed file types:gif|png|jpg|jpeg & file size max 2mb)
First Name :
Last Name :
Relationship to nominee (ie. Family member, colleague, coach, organisation) :
Before you submit your nomination, please print a copy for your records
2014 All Rights Reserved. DSRF. Website Design by Semcore