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  • DSR Awards 2016 Nomination Form – Team of the Year

    Nominee Details

    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? *:

    Nominated by

    I am self nominating.

    First Name * :

    Last Name * :

    Address * :

    Suburb * :

    State * :

    Postcode * :

    Mobile * :

    Email * :

    Relationship to nominee (ie. Family member, colleague, coach, organisation) * :

    How did you find out about the awards?

    Please specify the other


    Questions - Team of the Year


    1. In the past twelve months, the nominee has participated:
    Please select all that are applicable.

    2. The following relate to the nominee’s impact. The nominee has:
    Please select all that are applicable.

    Please provide further explanation (maximum 50 words)

    3. The following relate to the nominee’s attitude and sportsmanship. The nominee has:
    Please select all that are applicable.

    Please provide further explanation (maximum 50 words)

    4. Please summarise the nominee’s achievements in 150 words or less.

    Extra Information

    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)

    Photo 1:

    Photo 2:


    Who can we contact in support of this nomination?
    Please provide at least one reference.

    Referee details


    Referee One

    First Name * :

    Last Name * :

    Email * :

    Mobile * :

    Relationship to nominee (ie. Family member, colleague, coach, organisation) * :

    Referee Two

    First Name :

    Last Name :

    Email :

    Mobile :

    Relationship to nominee (ie. Family member, colleague, coach, organisation) :

    Before you submit your nomination, please print a copy for your records