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2021 Victorian Rural Health Awards: Nomination Form

2021 Victorian Rural Health Awards: Nomination Form

Please read the 2021 Victorian Rural Health Awards Nomination Information document before you begin.

Nominations can be submitted by filling in the below form or emailed to communications@rwav.com.au.

  • 2021 Victorian Rural Health Awards Nomination Form

  • Nominator Details

  • Nominee Details

    Please select which category you are nominating this person for. Nominators can select multiple award categories as long as the criteria is met and rationale has been given.
  • Please include the health service name and location.
  • Nomination Statement (minimum 250 words)

    Please outline why you are nominating this health professional and what activities they have undertaken that show significant outstanding contribution beyond normal professional expectations. Include as much detail as possible about the nominee’s professional career, achievements and/or community involvement. Please address the selection criteria in the 2021 Victorian Rural Health Awards Nomination Information document (Minimum 250 words).
  • Supporting Documents

    Please attach at least one supporting document to support your nomination such as media, news articles, letters of recommendation, published journal articles, etc. If attaching an image, please make sure the file is less than 2500 pixels.

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