PO Box 135 CLAREMONT WA 6910

T: (08) 6263 3168 E: janice.davidson@raswa.org.au

NOMINATION OF CANDIDATECANDIDATE DETAILS NAME: Prefix:       Full Name:       Suffix:       Most Recent Address:       Post Code:      

Telephone Number (if known):       Mobile:      

Email address (if known):      

Date of Birth:       Place of Birth:      

Name of Spouse (if applicable):      

Name of Children (if applicable):      

Date of Death (if applicable):      

If deceased, please provide Candidate’s Next of Kin/Representative:      

Next of Kin Address:      

Next of Kin Telephone Number:      

NOMINATION CRITERIAIn making selection, recognition of the nominee’s significant contribution and influence on the history of Western Australian agriculture, primary production and/or rural life needs to be evidenced and detailed.

In completing your nomination please be aware that the Selection Panel’s focus in evaluating nominations for this award will be:

A demonstrated achievement at a high level; A contribution and influence on the history of Western Australia over and above what

might reasonably be expected; A voluntary contribution that stands out from others who may have also made a

valuable contribution; The impact and value of the contribution to agriculture and related industries in

Western Australia; The breadth of influence that the candidate had which extends beyond their own

community.

Complete those Sections relevant to the Nominee.Limit to 8 - 10 pages

RESUME OF CANDIDATESECTION 1

AGRICULTURAL / RURAL CONTRIBUTIONS

Under headings below (where applicable ) outline the nominee’s contributions, impact, breadth of influence, value and/or leadership on the history of agriculture, primary production and/or the rural community in Western Australia.

PART A: Agriculture and Primary Production

     

AND/OR

Rural Community

     

PART B:Detail any other contributions to the State of Western Australia.

     

SECTION 2

Include a short chronological summary of involvement in organisations, associations, industry bodies, both State and Nationally and education and training (formal or otherwise) if known.

     

SECTION 3

Additional information deemed to be pertinent to the nomination.

     

SECTION 4Provide supporting documentation eg correspondence, articles, testimonials etc. The links to relevant websites can be included as supplementary support. Include extracts of any significant information from the supplementary material, under the relevant Section above.

     

Complete those Sections relevant to the Nominee.Limit to 8 - 10 pages

NOMINATOR DETAILSName of Nominator/Organisation:      

Name of Organisation Contact:      

Contact Address:       Post Code:      

Telephone:       Mobile:      

Email:      

REFEREES

Please nominate two referees if Selection Panel requires endorsement.

Name:      

Phone:       Email:      

Name:      

Phone:       Email:      

SIGNATURE:Typing your name below forms your signature and confirms that all information provided on this form is accurate and true to the best of your knowledge.

Nominator:      

Complete those Sections relevant to the Nominee.Limit to 8 - 10 pages

SUPPLEMENTARY INFORMATION

NOMINATION SUBMISSION

Submit Nominations for 2021 Induction by Friday 28 August 2020.

To: Agricultural Hall of Fame, (Confidential)Post: RASWA, PO Box 135, CLAREMONT WA 6910Email: janice.davidson@raswa.org.au

NOMINATION INFORMATION

This award is one of the most prestigious agricultural recognition awards given in Western Australia. The information provided is to reflect the lasting influence and impact the candidate’s career has had across the agriculture and primary food industries and/or rural life in Western Australia.

The Nominator is requested to address the relevant criteria under each Section, giving as much detail as possible, but limiting the nomination to 8 to 10 pages. This does not include any supplementary material. We suggest a brief and succinct bullet point format to your presentation.

Please provide: Personal details; dates; positions held; Demonstrated high level achievement and impact on industry and/or rural community; Supporting documentation, including extracts of any significant information under the relevant

Section.

A Supplement may assist the Selection Panel in making a sound decision.

Current RASWA Councillors and staff are not eligible for nomination.

The Agricultural Hall of Fame luncheon and induction ceremony for the selected 2020 inductees will be held in April/May 2021.

In the 12 months following the induction of successful candidates, portraits are painted of each inductee which are then unveiled in a separate ceremony after the next Induction function.

The Portraits of the inductees are displayed in the Agricultural Hall of Fame House, Claremont Showground.

For information on Agricultural Hall of Fame and the Inductees please visit: https://www.raswa.org.au/scholarships-and-awards/agricultural-hall-of-fame/