Bravery award nomination

Girl Guides Australia Adult Good Service Award Nomination - Bravery

The aim of the Bravery Awards are to recognise a member who has committed an act of bravery or heroism.

The nominee needs to have committed an act of bravery or heroism.
The application is to be made without the knowledge of the recipient.
It is the Proposer’s responsibility to ensure all information to support this nomination is included.
There is information to assist you to complete this form in short explanations beneath some questions and in Guide Lines.
When completing this online form you may save and return to it at any time, you can make changes as necessary and leave blank any questions you are unable to complete.

Information about you

Your name (the proposer): *

Briefly describe how you know the member you are nominating.

Your email address: *

Best phone number to contact you on: *

Information about the member you are nominating for a bravery award (the nominee).

Name of nominee: *

The nominee is based in which State?

Nominee's contact email address:

Nominee's contact phone number:

What is the nominee's current position in Guiding?

Description of what happened

Tips for continuing to complete this form.

When asked for descriptions or examples please give the best example/s you can or write N/A for Not Applicable or leave the answer box blank.

Answer questions in a style that suits you! Dot points (begin your text with the star character or a dash),short sentences or papragraphs - the Awards Committee just want to know about the nominee and what happened.

Please compete the following questions:

Why are you nominating the member for a bravery award? Please describe what happened in detail.If you witnessed the act please describe in your own words what happened in detail. Alternatively please summarise any eye witness accounts of what happened.

Witnesses / supporters

If there are other people who can provide additional information in support of this bravery award nomination please complete details below. If there are no additional witnesses / supporters please leave the following questions blank.

Name of witness / supporter

Witness / supporter email address

Witness / supporter best contact phone number

Please describe how the witness / supporter was involved in what happened

Name of witness / supporter

Witness / supporter email address

Witness / supporter best contact phone number

Please describe how the witness / supporter was involved in what happened

Certificate and presentation

Aspects of the nomination which you would like highlighted in the Certificate CitationYou are not expected to write the citation for the certificate! This is an opportunity for you to highlight any specific points you would like included in the citation.

Do you have a specific event / date where you would like the certificate to be presented?It would be appreciated if the selected date was at least 2 months ahead from when the nomination is submitted.

Additional information to support nomination

Are there any additional comments you would like to make in support of this nomination (including anything about the nominee that you would like the Awards Committee to know)?

If required, do you give permission for a member of the Awards Committee to contact you in relation to this Award nomination?

YesNo

OPTIONAL: If there is anything you would like to upload in support of this nomination such as photos, written documents, articles, videos etc? If yes, please upload here - your maximum file limit is 10MB per nomination. Please note that letters of support are not required however if you have written comments / material in support of the application then this can be uploaded.

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Approval of Nomination by the State Commissioner

Email address of the State Commissioner *When you click on the submit button this nomination form will automatically be sent to the email address you type in here for processing.

Name of the State Commissioner *

Proposer's Declaration: Checking this box forms your signature and confirms that all information provided on this form is true and correct to the best of your knowledge. *

Date of completion *

State Commissioner to complete

First name

Second name

Current position in Guiding (if not being completed by State Commissioner)?

Do you support this nomination being processed?

YesNoWould like to talk with the State Awards Chair about the nomination

Are there any comments you would like to make in relation to this completed gallantry award nomination?

State Commissioner (or delegate) to sign

Clear

Please sign using your mouse / keyboard mouse as your pen.

Date of signature

Please type in the email address of your State Awards Committee Chair *When you click on the 'submit' button this form will automatically be emailed to the Award's Chair using the email address you typed in

When you are satisfied that your part of the nomination process is complete, click the submit button and your nomination form will be automatically sent to the email address you nominated or to a relevant default email.

Girl Guides Australia (GGA) and the State Girl Guide Organisations (SGGOs) (collectively known as Girl Guiding in Australia) are bound by Australian Privacy Laws, recognise the importance of privacy and are committed to protecting the personal information. For information on how your information is collected, used or disclosed please refer to the Collection Statement.

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