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Nomination Form

Privacy Disclaimer: By nominating a person in the Australia Day Awards, you are providing Logan City Council with your and the nominee’s name, address and contact details. This information may be used in print and electronic media including flyers and promotional materials and may be given to the media for the purpose of acknowledging commendable achievements as part of the Australia Day Awards. The information will be accessed by employees and/or Councillors of Logan City Council and will be handled in accordance with the Information Privacy Act 2009. Your information will not be given to any other person or agency unless you have given us permission or we are required by law. Category

Select category *
Nominee
Date of Birth *
Nominator
Date of Birth *
How did you hear about the awards? *
Is the nominee a current Logan resident? (Non-residents are ineligible for this award) *
Has the nominee received this award previously? (Previous winners are ineligible for this award.) *
Is the Nominee aware of the nomination? *
I agree that I have permission from the person or organisation I am nominating to disclose their personal information as part of their entry in the City of Logan Australia Day Awards. I confirm that permission has been granted for Logan City Council to use photos, audio, or video in which the nominee or nominator appear for use in online reports, marketing materials and media releases/interviews. *
Selection Criteria
Please provide examples of work they have undertaken*
Describe qualities the nominee possesses which make you want to nominate them
5MB maximum file size
You may also upload other supporting materials such as photos and newspaper articles as supporting material.
Agree
By ticking this box you agree that all the information supplied is true and correct and agree to the conditions of nomination *