© 2018 - Victorian Aboriginal Child Care Agency
Graphic design by Reanna Bono
Youth Award Nomination Form
Nominee Details
Name
*
Address
*
Street Address 1
Street Address 2
City
State
Post code
Phone
*
Email address
*
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
Where does the nominee work?
*
Please provide a brief bio of the nominee
*
Bio's of young people will only be used for judging purposes. They will not 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 Youth Award
Youth Award Details
How old is the young person you are nominating?
*
14
15
16
17
18
None of the above
The youth award is for Aboriginal young people aged 14-18 years of age, please consider nominating under another category.
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How long has the nominee been in Out of Home Care (kinship, foster or residential care)?
*
To be eligible for the Mollie Dyer youth award the nominee must have been in OOHC for more than 12 months.
How has the nominee shown strength, advocacy and leadership, and inspired positive change?
*
1500 characters max or 2 minute video. Response can be written or submitted via video.
Video response
Max 60MB
If you are having difficulties uploading your video just contact us at awards@vacca.org
