Second Referee

Please attach documentation to support your nomination.  (i.e. awards, certificates, academic transcripts, thank-you letters, newspaper articles etc)


​​​Please ensure that your answers to the award category you are applying for address the "WHAT ARE THE JUDGES LOOKING FOR?" section of the award category

Nominee's Details

Privacy Disclaimer

All personal information collected by the Maryborough Neighbourhood Centre is protected by the Privacy Amendment (Private Sector) Act 2000.  The Maryborough Neighbourhood Centre is committed in protecting the privacy of personal information disclosed to us.  The centre collects personal information in order to properly and efficiently carry out its functions and only uses personal information for the purposes for which it was given to us and for directly related purposes.  However, be advised that your personal information may be disclosed to the Chief Executive Officer of the Queensland Government, Department of Communities, Child Safety & Disability Services which is our main funding body, for the purposes of ensuring that the Maryborough Neighbourhood Centre is providing quality service that meets certain standards.

Nominator's Details

Please indicate two (2) people (other than the nominee or nominator) who are conversant with the nominee’s achievements and who would act as referees for this nomination.

Fields marked with a red asterisk are required

If you are unable to click the submit button please check to see if you have missed a required field

​​​​​2019 Fraser Coast Youth Achievement Awards Nomination

First Referee