Awards nomination form - Mental Health Matters Media Award

Recognising individuals or organisations who have produced thoughtful, informative and responsibly reported media relating to mental health illness. Can be Australia-wide or state-based. Please note: Nominations should be published or broadcast in commercial media (e.g. newspapers, television stations) or public media (e.g. ABC radio, community radio). Nominees wishing to nominate internal organisational or promotional items (e.g. organisational magazines or newsletters or promotional radio spots) should consider submitting in another award category such as the workplace award, or the mental health promotion award.

Nominator's details

Nominator's name*

Position

Phone*

Email*

Nominee details

Please provide contact details of the program/project or individual you are nominating

Program/Project name*

The name of the specific program/project or initiative you are nominating

Organisation/group/company name*

The name of the organisation which is running the program/project

Nominee contact name*

Nominee contact email*

Nominee contact phone*

Street address*

Address 2

Suburb*

State*

Postcode*

Nomination Criteria

To submit a nomination in this category, address the following criteria to support this nomination (the supporting information cannot exceed 1500 words).

1. Provide a brief description of the media submission*

2. Provide a summary of the evaluation data, outcomes and any formal or informal feedback.*

3. Please provide a link for any supporting media that can be accessed via the web*

May include (but not limited to) links to written articles, links to reviews of the program/project, links to videos or advertisements

Please attach any supporting documents

Can include evaluation reports, published materials, etc

Drag and drop files here or

How did you hear about the Mental Health Matters Awards*

Select or enter value

Other:

Disclaimer

The Mental Health Matters Awards are judged solely on the content provided to WayAhead - Mental Health Association NSW (WayAhead) with each nomination and with minimal additional checking performed by the selection panel. WayAhead relies on the information provided by the nominees and their declaration as to its accuracy and completeness and the inclusion of nominees in the list of nominees and the issue of an Award or commendation to a recipient ("Award recipient") is not an endorsement or recommendation by WayAhead of the Award recipient's products or services. Users of products or services supplied by nominees or Award recipients should satisfy themselves that they are appropriate, of suitable quality and adequate for a user's particular needs.WayAhead gives no warranties and makes no representations as to the suitability or fitness of particular products or services for the particular uses or purposes of any user and accepts no responsibility for any loss, damage or claim arising in any way from the use of any such products or services.

Declaration by nominator

I declare that: - All the information submitted in this nomination form is true and accurate in all material respects and is not misleading or incomplete in any material way. - The information submitted complies with the criteria of the Mental Health Matters Awards and the nominee is eligible to be nominated. - There are no facts or circumstances which would, if disclosed, disqualify the nominee or, if any Award or commendation is made to the nominee, would result in that Award of commendation being withdrawn. - The products and services provided by the nominee comply with all applicable laws and are suitable and fit for the purposes for which they are provided and there are no unresolved significant complaints or claims relating to the nominee's products and services. - There are no facts or circumstances relating to the nominee which, if any Award or commendation is made to the nominee, may harm the reputation of WayAhead. - I am authorised to make this declaration on behalf of the nominee

I have read the above and agree*

Date

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