Maroondah LogoCitizen of the Year – nomination form

Maroondah City Council is seeking nominations for the Citizen of the Year Award for an individual who has made an outstanding contribution to the community of Maroondah during 2020. The person does not need to be a resident of Maroondah, but their contribution MUST be substantially to the community of Maroondah.

Applications close 5pm, Sunday 28 November 2021. 

 
Details of person being nominated
Full name
Home address
Email address
Mobile
Telephone (BH)
Telephone (AH)
Occupation
Date of birth
Contribution/s to the community by the person being nominated
Other significant contributions or achievements
Past or present membership of community/sporting/professional bodies etc.
Other relevant background information
People that can be contacted for further information about the nominee – Person 1
Name
Position
Address
Postcode
Phone
Email
People that can be contacted for further information about the nominee – Person 2
Name
Position
Address
Postcode
Phone
Email
To be completed by the person submitting the nomination
Full name
Email
Address
Suburb
Postcode
Organisation represented (if any)
Phone