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Online Form - Volunteer Honorarium Nomination

Please complete the following form to nominate a volunteer for a one-off honorarium payment in recognition of their services in the Shire.

This honorarium can be awarded up to the value of $500.

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Note: Incomplete forms are kept for a period of 2 day(s), after this time the system will automatically delete your response.

Eligibility

- Only community members who volunteer within the Shire of Capel are eligible for nomination.
- The nominee must provide significant and valuable services to the community.
- The nominee should have a track record of consistent volunteering over a substantial period of time.
- Nominations can be submitted by any member of the community who has personally witnessed or directly benefited from the nominee’s services.
- Volunteers can only receive one honorarium payment per year.

Nomination Process

- Any community member can submit a nomination for a volunteer, including self-nominations.
- Nominations must be submitted using the nomination form available through the Shire’s website or a hard copy form can be obtained from the Shire Administration Office or any Shire Library.
- Nominations should include detailed information about the nominee’s volunteer activities, their impact on the community, and any relevant accomplishments.
- The nominator should provide their own contact information for follow-up purposes.

Selection Committee

- A selection committee will review and assess the nominations.
- The selection committee will consist of Shire Councillors and Shire Officers.
- The selection committee will be impartial and fair in their evaluation of nominations.
- The decision of the committee will be final and not subject to appeal.

Selection Criteria

- The committee will consider the nominee’s dedication, impact, and commitment to communities in the Shire.
- The quality and significance of the services the nominee offers will be considered.
- The committee will consider the length of volunteer service and consistency of involvement.
- The impact of the nominee’s activities on the community will be a key factor. Where applicable, provide specific examples of projects or events the volunteer has been involved in and the outcomes achieved.

Honorarium Amount

- The honorarium payment will not exceed the value of $500.
- The selection committee will determine the specific amount based on the nominee’s contribution and the available budget.

Recognition and Award Cermony

- Chosen recipients of the honorarium payment will be announced at the Shire’s annual Outstanding Volunteers’ Breakfast in December.
- The honorarium payment and a certificate of recognition will be presented to the recipients during the Breakfast.
- The Shire’s website and social media platforms will be utilised to share the stories of the recipients.

Nominator Information

Name*

Email*

Phone Number

Nominee Information

Name*

Email Address*

Phone Number*

Please describe the volunteer's roles and responsibilities within the Shire*

How long has the nominee been volunteering for the Shire?*

Please provide a detailed description of the contributions and the impact made on the community*

Please provide specific examples of initiatives the volunteer has been involved in and the outcomes achieved*

How has the volunteer demonstrated commitment, dedication, and reliability in their service?*

Is there any additional information you would like to provide to support your application?

Declaration

I declare that the information provided in this application is true and accurate to the best of my knowledge.

I understand that the decision of the selection committee is final and not subject to appeal.

Declaration*

Yes

Attachments

Please attach at least one photo, (preferably three)
This is mandatory for submission validity.

Photographs*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

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