2020 Youth Civics Leadership Day

Teacher details

Name of school*

Title

First Name*

Surname*

Teacher's email address*

Enter email Confirm email

Teacher's phone number

Nomination Criteria*

I confirm that the students nominated from my school meet the following criteria.

The nominees are Year 10 students
The nominees have not had the opportunity in the past to represent the school or attend a similar event
The nominees have demonstrated leadership potential and/or civic awareness potential within their school and/or community

Nominee 1

Title

First Name*

Surname*

Please select*

Indigenous
Non Indigenous

Brief description of nominee’s leadership and/or civic awareness potential in the school and/or community:*

Emergency contact person

Full Name*

Emergency Contact Number*

Subway lunch order

Choose your sub*

Foot Long
6 inch

Bread*

Filling*

Special Dietary Requirements (e.g. allergies, vegetarian, Halal etc)

Nominee 2

Title

First Name*

Surname*

Please select*

Indigenous
Non Indigenous

Brief description of nominee’s leadership and/or civic awareness potential in the school and/or community:*

Emergency contact person

Full Name*

Emergency Contact Number*

Subway lunch order

Choose your sub*

Foot Long
6 inch

Bread*

Filling*

Special Dietary Requirements (e.g. allergies, vegetarian, Halal etc)

Name

This field is for validation purposes and should be left unchanged.

Nomination Form

Teacher details

Nominee 1

Emergency contact person

Subway lunch order

Nominee 2

Emergency contact person

Subway lunch order

Your Cart