HALL OF FAME NOMINATION FORM | WA Womens Hall Of Fame

SUBMITTED BY

Your name *
First
Last
For use by WA Women’s Hall of Fame Inc only

Association to Nominee

Your Address
Address Line 1
City
State / Province / Region
Postal Code
Your Nominee’s consent is not required to make this nomination. If selected, further consent and additional information from your Nominee will be sought at that time.

Your daytime phone/mobile

Your email *

NOMINEE'S DETAILS

Name *
First
Last

Phone

Email *

Date of birth (if known)

Place of birth (if known)

Current address (if known)
Address Line 1
City
State / Province / Region
Postal Code

Current postal address *
Address Line 1
City
State / Province / Region
Postal Code

Is the Nominee Aboriginal and/or Torres Strait Islander?
Aboriginal
Torres Strait Islander

Is the Nominee from a Culturally and Linguistically Diverse background?
Yes
No

Is the Nominee from a Rural and/or Remote WA Community?
Yes
No

Does the Nominee have a lived experience of Disability?
Yes
No

REASONS FOR NOMINATION (supporting documentation can be attached if required)

The 2024 WA Hall of Fame Inductees will be selected for distinction in one of the following eight categories. Review them all and then choose the category/s where you believe your Nominee has made the greatest contribution.
Arts
Business
Community
Culture
Education
Health
Sport
STEM & Technical Trades
Each woman can only be nominated in a maximum of two categories. Note: The selection committee may opt to include the nominee in an additional / alternative category.

REASONS FOR NOMINATION

Please provide a summary statement explaining why you are nominating this West Australian woman and believe they merit a place in the WA Womens Hall of Fame; outlining how your Nominee has contributed to Western Australia, in her local community, region or statewide, and excelled in her professional and/or personal life. (Word limit - 400 maximum words)

Explain how the Nominee has significantly contributed to the community, history, culture and/or economy in this State, and what lasting impact this Nominee’s actions, dedication, and/or achievements has had in Western Australia? (Word limit – maximum 300 words)

Has the Nominee had difficulties or challenges to overcome, and/or were there sacrifices related to her achievements? (Word limit – maximum 300 words)

How do you believe this Nominee has helped foster, inspire, and encourage Western Australian women? Why is she a good role model for younger women? (Word limit – maximum 300 words)

Is there evidence of innovation in their endeavours where this Nominee has initiated, and developed new ideas, created new alliances, or brought greater attention to an issue? Has she engaged in voluntary work beyond her paid work? This may include additional activities such as mentoring programs, involvement in community and service groups, or participating in Boards/Committees. (Word Limit - maximum 300 words)

What do you believe are the Nominee’s greatest achievement/s, including any awards and/or honours? Please list in bullet form only. (Word limit – maximum 200 words)

Please advise of any other web links, articles, or attachments you would like the committee to look at as part of your submission.

Your nominee’s consent is not required to make this nomination. If your nominee is selected to be inducted the WA Women’s Hall of Fame will seek further consent and additional information from your nominee.

Does your nominee know they have been nominated?
Yes
No

Please confirm that you understand: If this Nominee is selected, they will be asked to provide consent for the WA Women’s Hall of Fame to use any video or photos for promotional purposes. I acknowledge that if my nominee is selected any images provided to and created by the WA Women’s Hall of Fame for promotional purposes will be used without any personal compensation or remuneration to me or the Nominee.
Yes
No

Please confirm that you have read and understand the Terms & Conditions. *
Yes

IF YOU HAVE FURTHER DOCUMENTATION – PLEASE UPLOAD HERE

Click or drag files to this area to upload. You can upload up to 4 files.