Pride of Australia Northern Territory News Nomination Form
Published on: Mar 4, 2016
Transcripts - Pride of Australia Northern Territory News Nomination Form
10 — Sunday Territorian, Sunday, June 20, 2010 www.sundayterritorian.com.au
Title: Mr Mrs Ms :emantsriF:emanruSrehtO
Date of birth: (If not known, approximate age)
Is the nominee an Australian citizen? Yes No Not sure Nominee’s country of birth (if known):
Street Address (or Postal Address):
)W((if known) (H):enohP Mobile:
nominee’sdetails (Details of the person or group you are nominating. Please provide as much information as possible.)
Please tick this box if you are nominating two or more people in the Outstanding Bravery, Heroism, Community Spirit, Care and Compassion
or Environment categories. (Please attach additional nominees on a separate piece of paper)
Tell us in at least 100 words about your nominee and why they deserve a prideofaustralia™medal. How have they inspired you or contributed to
your life or the lives of others in the community? (Please write or type on a separate A4 sheet of paper and attach it firmly to this form).
How did you find out about the prideofaustralia™medal?
Title: Mr Mrs Ms :emantsriF:emanruSrehtO
Street Address (or postal Address):
nominator’sdetails (Your details)
Please tick this box if you do not wish to be identified
as the nominator to the nominee.
Please tick this box if you do not wish to be contacted in
future years in relation to the prideofaustralia™
Please tick this box to confirm you have read Rules of Entry.
The prideofaustralia™medal honours Australians who
do extraordinary things – the unsung heroes of our
communities whose contribution to Australian life is
not widely known.
These people are not high-profile Australians.
They might be a friend, workmate, neighbour, your child’s
teacher, the local police officer or firefighter or simply
someone who has made your community a better place
to live – you can even nominate yourself.
If you know someone who has contributed to the
community and reflects the core value of giving and not
receiving, then fill out the nomination form below with as
much detail as possible.
(Note: Supporting information supplied will
not be returned)
Outstanding Bravery Medal: For an Australian, or group
of Australians, who, through their act/s of bravery, helped
save or attempted to save a life/lives.
Courage Medal: For an Australian, whose act/s of
courage have overcome personal adversity through
determination and strength of character.
Heroism Medal: To recognise a member or members
(professional or volunteer) of the police, ﬁre, ambulance,
coastguard, air rescue service who work, or have worked,
on the frontline to protect the community.
Community Spirit Medal: To recognise an individual or a
group whose selﬂess and largely unacknowledged actions have
enriched the lives of those around them in their community.
Child of Courage Medal: A child 16 years or under who
has helped save, or attempted to save, the life of another or
overcome personal adversity through strength of character.
Young Leader Medal: A person under 25 years who has
advanced a community, or will advance a community,
through academic or personal endeavours.
Care and Compassion Medal: To recognise a
professional or volunteer carer or group, nurse or member
of the medical profession who has made a signiﬁcant
improvement to the lives of those around them.
Inspiration Medal: To recognise a member of our
teaching profession in primary or secondary school, State
or Independent, who has been truly inspiring.
Environment Medal: For an Australian or group of
Australians whose actions prove that by making one
degree of difference to their local environment, people can
make a difference to the broader community.
Fair Go Medal: For an Australian permanent resident
or citizen, born overseas, who has enriched Australia
through their honesty, hard work and willingness to
embrace their new home.
Serving Australia Medal: For an Australian in the
defence force, on or off the frontline, who showed
extraordinary courage and devotion to duty under extreme
circumstances or a former member of the defence force
who continues to serve their community and country.
NOMINATIONS CLOSE 5pm, TUESDAY, JULY 6, 2010.
Send the completed form and additional documentation to:
GPO Box 1300, Darwin, NT 0801.
Or you can nominate someone online at www.prideofaustralia.com.au
Should you require help with your nomination please call (08) 8944 9900
between 9am and 5pm Monday to Friday.
You will need to read the Rules of Entry carefully which are available online at
www.ntnews.com.au/pride or at NT News reception, McMinn Street, Darwin.
Please tick the appropriate category box for your
nominee. You may only select one category:
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*Kate Smith: Winner of 2009 Victorian and national prideofaustralia™ Young Leader medals.