2025 Community Changemaker - Fraser Coast Ability Awards

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Fraser Coast Ability Awards - Application Form

Community Changemaker

For an Individual who has make an outstanding contribution to the community through engagement, leadership and advocating for the rights and well-being of people with a disability.  This individual goes above and beyond.

This can be a person with a disability, teacher, allied health professional, caregiver, coach etc. 

It cannot be an organisation CEO or Director or those removed from direct care service delivery.

How Do you Wish to Lodge your nomination
Clear the selected value for How Do you Wish to Lodge your nomination

Nominator - Your Details (Not Applicable)

This section is not applicable because of your response to question: "How Do you Wish to Lodge your nomination" on page 1

Clear the selected value for Applicant
Must be an Australian phone number. 
Must be an email address. 
Must be an Australian phone number. 

Nominee - person / organisation you are nominating (Not Applicable)

This section is not applicable because of your response to question: "How Do you Wish to Lodge your nomination" on page 1

Must be an email address. 
Must be an Australian phone number. 

Selection Criteria (Not Applicable)

This section is not applicable because of your response to question: "How Do you Wish to Lodge your nomination" on page 1

Word count:

Referee (Not Applicable)

This section is not applicable because of your response to question: "How Do you Wish to Lodge your nomination" on page 1

Clear the selected value for Referee
Your reference must be someone who is familiar with your organisations project or if your individual achievements
Must be an Australian phone number. 
Must be an email address. 

Examples or Evidence (Not Applicable)

This section is not applicable because of your response to question: "How Do you Wish to Lodge your nomination" on page 1

Please upload any examples or evidence that you would like to share with assessors

Attach a file: Select stored file

    Privacy and Information Waiver (Not Applicable)

    This section is not applicable because of your response to question: "How Do you Wish to Lodge your nomination" on page 1

    By submitting this nomination, we agree to the details provided on this form being made public and consent to information, photographs and videos taken in connection with the election and awards process being used for promotional purposes, including published by media and on websites and at the presentation evening.

    Agreement
    Clear the selected value for Agreement

    Upload Video (Not Applicable)

    This section is not applicable because of your response to question: "How Do you Wish to Lodge your nomination" on page 1

    Please include

    • Your name and contact details
    • Applicants name and contact details
    • Details of a Referee
    • Answer the selection criteria
      • Clearly demonstrate a new, creative or significantly different approach that benefits people with a disability
      • Evidence of meaningful involvement or consultation with people with disabilities in developing the initiative
      • measurable impact and outcomes for individuals with disabilities or the broader community
      • scalability or potential for the innovation to be adopted or adapted by others
    • Show us or upload examples evidence
    Attach a file: Select stored file