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The WA Women’s Hall of Fame was first established in 2011 in recognition of the Centenary of International Women’s Day held annually on 8th March.

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ROLL OF HONOUR NOMINATION FORM

This category is for women who are no longer with us, so those who have passed can be acknowledged posthumously.

Please submit your nomination via this on-line form OR downloand the word doc and fill it in manually.

Click to download nomination form

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

Date of birth (if known)

Date of Passing (if known)

Place of birth (if known)

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

Does your nominee’s family / associates know she is being nominated?
Yes
No

Please confirm that you understand: If this Nominee is selected for the ‘Roll of Honour’, further consent, additional information and photo of your Nominee will be sought from their family at that time. I acknowledge that if my nominee is selected any images provided to and/or created by the WA Women’s Hall of Fame for promotional purposes will be used without any personal compensation or remuneration.
Yes
No

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 contributed to Western Australia, in her local community, region or statewide, and excelled in her professional and/or personal life. (Word limit – maximum 400 words)

Explain how the Nominee 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 had in Western Australia? (Word limit – maximum 300 words)

Did the Nominee have 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 helped foster, inspire, and encourage West Australian women? Why was she a good role model? (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? Did she engage in voluntary work beyond paid work? This may include additional activities such as mentoring programs, involvement in community or service groups, or participating in Boards/Committees. (Word Limit - maximum 300 words)

What do you believe were the Nominee’s greatest achievement/s, including 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.

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 10 files.

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