Community Achievement Awards for Regional Victoria
Nominations are now closed for 2021!

Please complete the details below for the individual/group/organisation/business you would like to nominate and we will get in contact with them and have them complete the official online nomination form - when nominations open in May 2022.

Terms & Conditions
Nominees must be residing in regional or rural Victoria for a minimum of 2 years (unless a permanent resident currently working, studying or pursuing their profession elsewhere), or the nomination activity must be specific to regional or rural Victoria.

*Regional Victoria refers to approximately 100km from Melbourne CBD.
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Your Details
Would you like to remain anonymous to the nominee? *
Please note: we require your details for our records, but if you select 'Yes' your details will not be visible to the nominee.
Full Name *
Company Name
Email Address *
Phone Number *
Nominee Details
Are you nominating an individual or business/group/organisation?
Nominee Company/Group - If Applicable
Nominee Full Name *
Nominee Email Address *
Nominee Phone Number *
Category you wish to nominate them into *
How did you come across this form? *
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