Outstanding Individual Achievement| Awards Forms

Outstanding Individual Achievement

Awarded to an individual in recognition of their significant and long-term contribution to the protection and improvement of Victoria’s coastal and marine environment.

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Nomination Details

This page relates to the project, person or group you are nominating

Please fill the following form

Project Title *

Name of group or organisation *

Street Address *

City or Town *

Postcode *

Contact person *

Position *

Mobile contact number *

Email address *

Website (if applicable)

Social media (if applicable)

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Nominator Details

This page relates to your details

Please fill the following form

Title *

Name *

Phone number *

Email address *

Position (if applicable)

Organisation

Briefly describe your relationship or involvement with the project/person/group

Please provide in 250 words or less a summary of the nomination. Please note that this summary may be used in promotional material for the awards, including media releases and on the VCC website. The summary should reflect the intrinsic nature of the award entry.

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Outstanding Individual Achievement

1. Explain how the individual’s actions have demonstrated outstanding leadership within the community.

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1 / 3

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Outstanding Individual Achievement

2. Explain how the individual has effectively mobilised others to contribute to the protection and improvement of Victoria’s coastal and marine environments.

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Outstanding Individual Achievement

3. Detail projects or activities that the individual has initiated or contributed to that deliver significant lasting positive outcomes for Victoria’s coastal and marine environment.

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Please provide two referees this may include yourself as the nominator but may not include the nominee. One referee must be independent of the project being nominated.

Referee One

Title *

Name *

Phone number *

Email address *

Relationship to project/person/group *

Position (if applicable)

Organisation

Referee Two

Title *

Name *

Phone number *

Email address *

Relationship to project/person/group *

Position (if applicable)

Organisation

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Award Recipient

Provide the name and contact details of the person(s) who will accept the award on presentation night if successful.

Title *

Name *

Street Address *

City or Town *

Postcode *

Phone number *

Email address *

Position (if applicable)

Organisation

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Images and supporting material

Images and supporting material that demonstrate the success of the nomination are highly encouraged. The submission, including attachments may not exceed 5MB and may only include 5 images.

If there is a requirement to provide large attachments or high resolution photographs, please supply these via post on a USB to:

Victorian Coastal Council
PO Box 500
East Melbourne Victoria 8002

Correspondence from the Victorian Coastal Council

All correspondence from the Victorian Coastal Council should be addressed to:
Contact details for nominator
Contact details for nominee
Both of the above

Terms and Conditions

By marking this box I indicate that I have read and agree with the Victorian Coastal Awards for Excellence Terms and Conditions of entry and the Privacy Statement, found on the Victorian Coastal Council website.

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