NAIDOC Community Award Nomination Form

Nomations to the 2025 NAIDOC Community Award will open from Sunday 6 July to Friday 31 October 2025. The award will be presented at the Civic Dinner in December 2025.

To make a nomination, complete the webform below or submit this nomination form via email to community.development@belmont.wa.gov.au or in person at the City of Belmont Civic Centre.

Please contact the Community Development team on 9477 7219 or community.development@belmont.wa.gov.au for more information.

Details of the individual being nominated

First name:*

Last name:*

Address:*

Suburb:*

Post Code:*

Email:*

Phone (home):

Please enter the phone number as 0890000000

Phone (mobile):*

Nominator's Details

First name:*

Last name:*

Address:*

Suburb:*

Postcode:*

Email address:*

Phone (home):

Please enter the phone number as 0890000000

Phone (mobile):*

Relation to nominee:*

Nomination information

Highlight the nominee's achievement in the selected category:*

Please address the Selection Criteria, detailing the Nominee’s achievements in a selected category, over the past 12 months.

Summarise how the nominee’s contribution/achievement has provided a direct benefit the City of Belmont community:*

Please supply any other relevant background information:

Please upload any relevant supporting documentation:

Declaration

I (the individual making the nomination) declare that the information provided is correct to the best of my knowledge:*

Yes

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