http://vinnies.org.au/files/%20-%20Nomination%20Form%202010%20-%20faxback

2nd Annual Vinnies Social Justice Awards 2010 Patron: Monsignor David Cappo AO, Commissioner for Social Inclusion

Nomination Form To be completed by the nominating organisation Name of Nominee / Group: ______________________________ Current Age: ____ (individual only) Nominating Body (Organisation):

_______________________

Year Level: _____ (if applicable)

Please tick one category you wish to nominate ( )

Emmanuel Bailly Award For ‘Young people serving the community and taking action to achieve social justice outcomes’ Group Nomination Rosalie Rendu Award For ‘Outstanding Service’ To an individual who has participated in a range of activities and is an integral part of the action

Blessed Frederic Ozanam Award For ‘Outstanding Leadership and Service’ To an individual who promotes social justice causes and shows leadership through action

St Louise de Marillac Award For ‘Post-Secondary Leadership and Service’ For a young adult (18-30 yrs of age) advocating for social justice through leadership and service during their postsecondary life

Tell us how your nominee meets the criteria for a Social Justice Award

.

Good Works undertaken in 2009  2010

Please attach a separate page if extra space is required.

Nominated by:

________________________________________________________________

Role/Position:

_________________________

Organisation: _______________________

Phone Number:

____________________

Email:

Postal Address:

________________________________________________________________

_______________________

(To send your tickets and Awards instructions)

Signature:

__________________________

Date:

_______________________

For more information about the Awards: http://www.vinnies.org.au/vinnies-social-justice-awards-sa Please keep a copy and return the form to Tim Taylor at St Vincent De Paul Society by 30 June 2010 Email: ttaylor@svdpsa.org.au | Fax: (08) 8112 8798 | Post: GPO Box 1804, Adelaide SA 5001 Important. Your Nomination will be acknowledged by email within 3 days. If a receipt email is not sent within this time please contact us immediately.

Y:\School Resources\_Social Justice Award Scheme\Noninations\Nomination Form 2010 - faxback.doc

2nd Vinnies Social Justice Awards 2010 Patron: Monsignor David Cappo AO, Commissioner for Social Inclusion

Acceptance of Nomination To be completed by the nominee (and parent if under 18) I (insert name) _____________________________________________________________________ accept the nomination for the __________________________________Award (Insert name of Award).

I understand that if my nomination is successful, I will be invited to attend the awards ceremony on evening of Wednesday 1st September at Nazareth College (Flinders Park).

Acceptance of my nomination is subject to the following criteria: 1. The nominee agrees that they have done the Good Works as outlined on the nomination form.

2. The nominee will present one PowerPoint slide telling the audience about their Good Works.

Presentation slide is to include your name, photo and dot points (no animation). The school may help with your presentation.

Sample templates are available at http://www.vinnies.org.au/vinnies-social-justice-awards-sa.

Nominee Details Given Name:

___________________________ Surname:

Current Age:

___________________________ Date of Birth: _____________________________

Home Phone: ___________________________ Mobile: Email:

_____________________________ _____________________________

_____________________________________________________________________

Home Address: _____________________________________________________________________ In the event that your nomination is successful, we need the following information: Audio / Visual Permission ( Please tick box) I give permission ( ), or I do not give permission ( ) for all images and audio-visual data (DVD, Video, Photos etc), taken as part of the Awards Ceremony, including those in the PowerPoint presentation, to be available for the St Vincent de Paul Society to use in printed materials, educational presentations, and online media, including the Society’s websites. The St Vincent de Paul Society commits itself to use all audiovisual material in a way that shows discretion, upholds the dignity of the individual and enhances the Society’s image.

Event Attendance ( Please tick the box) I will attend the Social Justice Awards ( )

I am unable to attend the Social Justice Awards ( )

Please reserve Guest Tickets for: 1 guest (Awardee plus one) or 2 guests (Awardee plus two) Signature of Nominee:

____________________________________

Signature of Parent / Guardian:

______________________________

Date: ____________ Date: ____________

(If nominee under 18)

The St Vincent de Paul Society hosts many activities that draw on the talents and skills of young people helping other young people. From time to time we would like to send you information about these activities. Please tell us if you would like to be contacted in the future. 

Yes, I would like to find out more about Vinnies Youth or St Vincent de Paul Society Activities.