ACCO Leaders Award Nomination Form

Nominee Details

Name*

Address*

Street Address 1 Street Address 2 City State Post code

Phone*

Email*

Is the deadly person you are nominating Aboriginal and/or Torres Strait Islander living in Victoria?*

Yes
No

The Mollie Dyer Award is celebrating Victorian Aboriginal Peoples and Torres Strait Islander Peoples dedication and leadership in the field of Aboriginal child and family welfare

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Where does the nominee work?*

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Please provide a brief bio of the nominee*

This will be used on social media and websites if the nominee is successful in becoming a finalist and winner.

Nominator Details

Name*

Phone*

Email*

A confirmation email will be automatically sent to this email address once the nomination has been submitted.

Organisation*

Are you nominating on behalf of an organisation? Have you received approval to do so?*

Yes
No

Relationship to the nominee*

Referee Details

Name

Phone*

Email

Organisation

Relationship to the nominee

Statement of support for the nominee to be awarded the Mollie Dyer Award for the Employee Award

Employee Award Details

How has the nominee in their work in the Aboriginal child and family welfare sector shown leadership, advocacy inspired positive change and worked to strengthen Aboriginal children and families in their role at their workplace?*

1500 characters max or 2 minute video Response can be written or submitted via video

Supporting Documentation

Max 60MB
Please upload supporting documentation for your nomination here.g

Video response

Max 60MB
If you are having difficulties uploading your video just contact us at awards@vacca.org