Annette Knight Community Leadership Medal

Please attach any relevant documents or materials that support this nomination, such as letters of recommendation, news articles, or photos – maximum five A4 pages, minimum font size 10 point.

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IAR.291.1.16/03/2026

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Nominee Details

Name*

Email Address*

Postal Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Phone Number*

Groups or charities the nominee is or has been involved with

Nominator Details

Full Name*

Email Address*

Postal Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Phone Number*

Do you wish your name to remain anonymous to the nominee?*

YesNo

Reason for Nomination

How has the nominee demonstrated outstanding leadership within our community? (Please provide specific examples and highlight any unique or innovative approaches they may have used)*

Length and type of service (How many years of service in each community organisation or charity, positions held, roles & responsibilities)*

What value have they brought to the community? (What is their legacy likely to be)*

Has the nominee been recognised elsewhere? (Please provide information on any other recognition the nominee has received)*

Do you have any other information on the nominee’s leadership you feel is relevant to the nomination? (Please provide details below)*

References

Please provide the name, and contact details of anyone who may be able to provide additional information to support the nomination.

Referee One

Referee Two

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