Applications | Leadership & Service | Leadership Enrichment | Nomination Form | Selection Process

NOMINATION FORM

Email to cmcaward@mercycare.com.au

THE CATHERINE McAULEY AWARD
PROGRAMMES POTENTIAL CANDIDATES

Please send an application kit to the following candidates:

1. Name: ________________________________________________________
Address: ______________________________________________________
Suburb/Town: __________________________________ Post Code: _____
Contact/Telephone No: _____________________________
Email address: ____________________________________

Leadership & Service Programme

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2. Name: ________________________________________________________
Address: ______________________________________________________
Suburb/Town: __________________________________ Post Code: _____
Contact/Telephone No: _____________________________
Email address: ____________________________________

Leadership & Service Programme

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

3. Name: ________________________________________________________
Address: ______________________________________________________
Suburb/Town: __________________________________ Post Code: _____
Contact/Telephone No: _____________________________
Email address: ____________________________________

Leadership & Service Programme

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I have discussed my nomination with the candidate(s) and is/are interested in receiving an application kit.

I am pleased for my name to be used in the cover letter to the candidate(s).

I am pleased to act as a referee for the applicants should they choose to apply.

I understand there is a closing date for applications and then an application, interview and selection process from which awardees will be selected, and that not all nominations are necessarily successful.

Name: _____________________________________________________________
Address: ___________________________________________________________
Suburb/Town: ________________________________ Post Code: ____________
Telephone: __________________________________
Email address:_______________________________

Thank you

2011 Nomination Form

Send to:
The Convenors of The Catherine McAuley Award
C/- PO Box 202 Wembley WA 6014
Ph: 08 9442 3491
Fax: 08 9381 9805
Email: cmcaward@mercycare.com.au

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