Heide Taylor Community Service Medal

Heide Taylor Community Service Medal and Prize

Nomination Form

This award recognises the work of Dr. HEIDE TAYLOR OAM, involved in Women’s Affairs for over forty years and countless activities related to the Status of Women; adviser to both Federal and State governments. 

  • The nominee does not have to belong to a service club
  • The nominee has been nominated for their volunteer efforts in an unpaid capacity
  • Give description of current, past and any other service to their community
  • Duration of service
  • Beneficiaries of the service
  • Impacts of the service
  • Referees if appropriate

Download  word doc nomination form

Please provide FULL and ACCURATE Club Information

Name of Submitting Club:          

ABN:

Postal Address:

Email:

President’s Name:

Name of Contact Person:

Contact Phone No:

Name and Contact Details of Nominee:


Name:

Postal Address:

Email:                                                                Phone:


Details of Nominee’s Community Service:  

Please attach a brief summary (no more than 750 words) giving specific details of the nominee’s service to the community.

All nominations must be received no later than Close of Business on 30th August 2019

Completed nomination forms should be emailed to

Peter Zander SCASA at applications@scasa.org.au

or by post to SCASA Nomination C\- PO Box 123, Park Holme SA 5043