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NOMINATION FORM Part A: Details of the nominator Name: Postal address: Phone number: Email: How do you know the nominee? Organisation and position (if applicable) Signature: Date: Part B: Details of the nominee (person being nominated) Name: Home address: Postal address: Phone number: Email: Nominee is being nominated for the following award: Outstanding Contribution by a Foster Carer Outstanding Contribution by a Kinship Carer Outstanding Contribution by a Territory Families Staff Member Outstanding Contribution by a Sibling Young Person Achievement Award* *Age of young person ____________

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NOMINATION FORMPart A: Details of the nominator

Name:Postal address:

Phone number:Email:How do you know the nominee?

Organisation and position (if applicable)Signature:

Date:

Part B: Details of the nominee (person being nominated)

Name:Home address:

Postal address:

Phone number:Email:Nominee is being nominated for the following award:

Outstanding Contribution by a Foster Carer Outstanding Contribution by a Kinship Carer Outstanding Contribution by a Territory Families Staff Member Outstanding Contribution by a Sibling Young Person Achievement Award*

*Age of young person ____________

Part C: Selection criteriaPlease outline the achievements of the person being nominated and the reasons why you believe they should be honored with an Award.

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Submitting your nominationPlease submit your application via email or post by Friday 6 October 2017.

Email: [email protected]

Mail: Foster and Kinship Care Awards 2017 Attention: Prue Carter Territory Families PO Box 40596

Casuarina NT 0811

If you have any questions please contact (08) 8999 2541.