Ministers Awards for Women in Local Government

Ministers’ Awards for Women in Local Government 2017 NOMINATION FORM

Nominee Details

Council Name

Council Classification Metropolitan Regional/Rural (see separate council classification list - available at www.olg.nsw.gov.au/our- minister/ministers-award-women-local-government)

Nominated for (please indicate type of Award)

ELECTED REPRESENTATIVE STAFF MEMBER

Category 1 Category 2 Category 3 Category 4

Mayor Councillor GM/Senior Staff Non-senior Staff Non-traditional Role

Position held:

Phone Number: Email Address:

Mandatory The nominee is a current female member of staff or a Yes No criteria female elected representative of a NSW council (elected representatives must have served during 2016, however do not necessarily have to be serving following the September 2016 Local Government elections).

of 4 Ministers’ Awards for Women in Local Government 2017 NOMINATION FORM

 I give consent for details about my achievements relating to this nomination, including any details contained in the nomination form and photographs taken at the Awards ceremony, to be used by the NSW State Government, ALGWA, LGNSW and/or LGPA for the purposes of showcasing and promoting the achievements of women in local government.  I confirm that the information provided about me in this nomination gives a full and complete picture of my achievements relating to this Award, and accurately reflects the facts.  I understand that I or my council is responsible for covering the costs of my attendance at the Awards ceremony, due to be held in Sydney on 7 March 2017.  I understand that I am not eligible to receive an award for a category in which I have previously been awarded.

Signature of Nominee (required) Date

Closing date for nominations is 5:00pm on Monday, 16 January 2017.

To be eligible for consideration for an Award, the nomination must:  Provide a summary of at least one specific example (agreed by the nominee and nominator) to support the nomination, demonstrating tangible outcomes.  Demonstrate how all Criteria (1 to 3) are met.  Be received by the closing date (5:00pm on Monday, 16 January 2017). The judging panel will be looking for individuals who have gone above and beyond their expected role to make a significant contribution to their council, their community and/or the local government sector in NSW.

Please provide a brief summary of the example that is being provided in support of this nomination. 200 words (maximum)

Enter Text Here

1 What outcomes were driven / achieved by the nominee in particular? Please provide a summary of outcomes achieved for the Council, the local government sector, and/or the community more broadly. What was the nominee’s role in achieving the outcomes? What made the project / activity unique? 100 words (maximum) Enter Text Here

How has the nominee provided inspiration, innovation and/or lead by example? Please provide specific examples of how the nominee has provided inspiration, innovation or has lead by example. Who did they inspire? How did they demonstrate leadership? 2 100 words (maximum) Enter Text Here

What has the nominee done to further the cause of women? Please provide specific examples of how the nominee has furthered the cause of women. For example, have they participated in activities to increase women’s participation in local government or within the community? Have they challenged gender stereotypes and 3 conventions? 100 words (maximum) Enter Text Here

Details of Nominator and Seconder Name of Nominator: Name of Seconder:

Position: Position:

Organisation: Organisation:

Phone Number: Phone Number:

Email Address: Email Address:

Signature of Nominator: (required) Signature of Seconder: (required)

Date: Date:

Please note: information on previous years' winners can be found on the Ministers' Awards for Women in Local Government webpage at http://www.olg.nsw.gov.au/our-minister/ministers-award- women-local-government

Please return the completed and signed form by email to [email protected] or by post to Ministers’ Awards for Women in Local Government, Office of Local Government, Locked Bag 3015, Nowra NSW 2541, or by fax to 02 4428 4199, no later than 5:00pm on Monday, 16 January 2017. For enquiries, please contact Bron Hewson at the Office of Local Government on 02 4428 4100.