WA Volunteer Service Awards Program
2026 Nomination Form
Volunteer self-nomination
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Volunteer self-nomination
Please ensure the spelling is correct as this will be displayed on the certificate of recognition
Name
*
Title
First Name
Surname
Date of birth
*
-
Day
-
Month
Year
Date Picker Icon
Postal address (Please ensure the address entered is correct as this is where Certificates will be posted to)
*
Address line 1
Address line 2
Town/Suburb
Postcode
Postcode
Phone
*
Email
*
example@example.com
Select nominating category
*
5 - 9 years of voluntary service
10 - 19 years of voluntary service
20 - 29 years of voluntary service
30 - 39 years of voluntary service
40 - 49 years of voluntary service
50 - 59 years of voluntary service
Lifetime of voluntary service (60 plus years of volunteering)
How many years have you been volunteering?
*
Describe your contribution in a brief summary:
*
0/100
Please provide an outline of your volunteering contribution (please list from most recent):
*
Organisation
name
Organisation
Phone number
Start
date
MM/YY
Finish
date
MM/YY
Organisation 1
Organisation
2
Organisation
3
Organisation
4
Organisation
5
Organisation
6
Organisation 7
Organisation 8
Organisation 9
Organisation 10
Organisation 11
Organisation 12
What region are you currently volunteering in?
*
Gascoyne
Goldfields/Esperance
Great Southern
Kimberley
Mid-West
North East Metropolitan
North West Metropolitan
Peel
Pilbara
South East Metropolitan
South West
South West Metropolitan
Wheatbelt
Metropolitan
What is the main focus area of the organisation where you are currently volunteering?
*
Aboriginal Community Controlling Organisation (ACCO)
Animal welfare
Culture/arts/tourism
Education/vocation/research
Emergency services
Environment
Health including disability service
Religion/spiritual
Service club
Social services/welfare
Sport or recreation
Youth Service
Other
Media consent
This allows the Department of Communities to use images and/or accounts of volunteer experience in a range of internal and external publications and media. This also includes photos taken at the WA Volunteer Service Awards ceremony.
I confirm that at the time of this nomination, I am of good standing and do not have any convictions, pending convictions or charges (within or outside Western Australia) that may impact on the reputation of the Department of Communities.
*
Yes
No - (if 'No' is selected, the nominee is not eligible)
I agree to the use of my nomination information for media, and to be available for media and promotion of my award.
*
Yes
No
Are you 18 or over?
*
Yes
No (if no, complete parental consent below)
Parent or legal guardian name and contact number
*
Full name
Contact number
By signing this form I provide my consent, as the nominee’s parent or legal guardian, to the submission of this nomination and for use of images and provided information for media and promotion of their award.
*
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By submitting this form you confirm the information provided is correct to the best of your knowledge.
*
I understand
Please verify that you are human
*
Submit
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