MY STORY
Nomination and registration form
Please use this form to nominate outstanding women from CALD community of Australia. Please nominate yourself or someone to be part of “MY STORY” Project. *
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Nominee’s Name *
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Nominee’s Contact/Email *
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Nominator’s Name *
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Nominator’s Contact *
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Representing Australia from *
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Residential Address *
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Community Organisation Referee contact *
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Work Referee contact *
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Personal Referee contact *
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1) Detail the nominee Bio Data, give specific true information's *
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2) Describe how the nominee achievement is Exceptional, give specific examples *
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3) Describe how the nominee demonstrates excellence in inspiring women and CALD community, give specific examples *
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4) List outstanding accomplishments, such as education, business, awards, community work, leadership, letters of appreciation, etc *
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I am available to attend consultation and registration event *
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I am available to provide days/date for filming *
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Declaration: I state that the information I have provided is true and correct to the best of my knowledge. I acknowledge that Fusion Media Production may refer this application to external parties for assessment, comment, or reference. I understand that this nomination may not necessarily be successful for selection on MY STORY project. *
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Consent to followings *
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